TITLE:
Therapeutic Management in Proximal Tracheal Rupture during Total Thyroidectomy
AUTHORS:
Victor J. Ovejero-Gomez, M. V. Bermudez-Garcia, J. L. Lamfus-Prieto, T. Gallego-Bellido, J. Villalba-Torre, A. Ingelmo-Setien, J. M. Bajo-Arenas
KEYWORDS:
Tracheal, Rupture, Iatrogenic, Thyroidectomy, Treatment
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.6,
June
24,
2014
ABSTRACT:
Tracheal disruption is a
life-threatening rare complication of total thyroidectomy that it should be
prevented. The own-patient risk factors, procedure of tracheal intubation and a
meticulous surgical technique are three main keys to keep in mind. Both medical
and surgical management of this injury depends on its size, location and
patient’s symptoms although neither of them prevents late complications. An
early diagnosis could improve with prognosis although it is mandatory to
perform either respiratory functional or imaging study in order to assume its
healing. When the tracheal laceration is diagnosed during the surgery, we
should take care with a continuous monitoring of the patient’s vital signs. A
good oxygenation will be succeeded in high volume and low pressure with
endotracheal tube distal to the lesion. We advice placing a tube drain near the
disruption to prevent emphysema and an early extubation to avoid an ischaemic
damage of the mucosa. A postoperative suspicion of tracheal rupture could
demand reintubation with the patient in full relaxation and an examination by
CT-scan or fiberscope before deciding a simple supportive therapy. We present
our therapeutic experience in a female patient who suffered from tracheal
injury during total thyroidectomy and describe a review of literature.