Airway compromise in thyroplasty surgery

Airway compromise arising from thyroplasty procedures including Isshiki type I through IV thyroplasties, arytenoid adduction, and arytenoid fixation is uncommon yet potentially life threatening. Identification of incidence of obstruction and probable causes is important for preoperative planning, consultation, and postoperative care.

Retrospective review of all thyroplasty operations, including arytenoid adduction and arytenoid fixation.

Three hundred thirty-two patients underwent a total of 630 thyroplasty procedures. Detailed information was gathered on patients manifesting symptoms of airway obstruction.

Seven patients required an unplanned tracheostomy for airway compromise. Five of 143 patients who underwent arytenoid adduction required a tracheostomy, for an incidence of 3.5%. The median interval to developing significant stridor requiring tracheostomy was 9 hours, with five of these seven patients requiring airway surgery within the first 18 postoperative hours. No patient receiving a type I thyroplasty alone developed significant airway compromise. Tracheostomy was required in two patients with underlying neuromuscular disease-one who underwent a bilateral type I thyroplasty and one who underwent an arytenoid fixation procedure.

The percentage of airway complications after thyroplasty is low. However, arytenoid adduction and fixation operations have a significant risk of postoperative temporary tracheostomy and warrant preoperative discussion regarding tracheostomy and postoperative overnight hospital admission.