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Venolaryngeal Obstruction Syndrome (VLOS): Characterizing Airway Obstruction in Massive Thyroid Goiters
Evan C Compton1, Christopher M Johnson1, Gregory N Postma1
1Medical College of Georgia, Department of Otolaryngology, Head and Neck Surgery, Augusta University, Augusta, GA, USA.
Objectives:
Characterize the presentation of chronic airway obstruction for patients presenting with massive thyroid goiters.
Methods:
Demographic data acquisition was undertaken on 5 patients who presented with a compressive goiter and had pre-operative severe airway obstruction secondary to supraglottic and laryngeal edema. Each patient had a resolution of severe airway obstruction post-thyroidectomy.
Results:
In all, 5 patients were diagnosed with severe airway obstruction due to chronic obstruction by a thyroid goiter. Several airway management interventions were pursued during definitive surgery (conventional or videolaryngoscopic intubation and a hybrid endoscopic approach incorporating the Seldinger technique). Successful thyroidectomy led to rapid resolution of laryngeal edema.
Conclusion:
Venolaryngeal obstruction syndrome is proposed as a term to describe the laryngeal findings in compressive goiters. The pathophysiological sequence resulting in chronic airway obstruction may have similar mechanisms to expanding neck hematomas after thyroid surgery.
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