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Thyroid surgery and anaesthesia following head and neck irradiation for childhood malignancy
L Delbridge1, J Sutherland, H Somerville
1Department of Surgery, University of Sydney, Royal North Shore Hospital, New South Wales, Australia. leighd@medusyd.edu.au
Background:
Increasing numbers of adolescents and young adults are undergoing thyroid surgery because of the risk of malignancy following previous irradiation for childhood malignancy. Irradiation to the head and/or neck regions may induce changes in the soft tissues and larynx that are far from normal with respect to both size and mobility. The aim of the present study was to evaluate the possible impact of such changes on both surgical and anaesthetic technique during thyroidectomy.
Methods:
This was a retrospective ease study. Thirty consecutive patients undergoing total thyroidectomy following previous irradiation for childhood malignancy formed the study group.
Results:
There were no permanent surgical or anaesthetic complications in the group. In particular there were no cases of either permanent recurrent laryngeal nerve palsy or permanent hypoparathyroidism. Twenty-eight patients had an uneventful intubation and two were unable to be intubated directly, one requiring fibre-optic bronchoscopic intubation and the other having surgery performed with a laryngeal mask following failed bronchoscopy. Both of these patients had received high-dose direct irradiation to the larynx for solid tumours.
Conclusions:
Despite potential difficulties associated with the heavily irradiated larynx, thyroid surgery and anaesthesia can be performed safely with minimal complications in experienced hands.