Airway Management for Tracheal Perforation After Left Hemi-Thyroid Lobectomy: A Case Report

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Otolaryngology

Background:

• Tracheal perforation is a rare but serious complication following thyroid surgery.
• Effective airway management strategies for these cases are not well-documented.
• This case highlights a successful approach to a challenging post-thyroidectomy airway complication.

Purpose of the Study:

• To report a case of successful airway management in a patient with tracheal perforation and necrosis after thyroidectomy.
• To emphasize the utility of awake fiberoptic intubation in managing complex post-thyroidectomy airway issues.

Main Methods:

• A 65-year-old female patient with a 3 cm erosive tracheal perforation post-thyroid lobectomy was evaluated.
• Airway management options including awake fiberoptic intubation, awake tracheostomy, and extracorporeal membrane oxygenation were considered.
• Awake fiberoptic intubation was chosen due to the perforation's location relative to the tracheal bifurcation.

Main Results:

• The endotracheal tube was successfully positioned above the tracheal bifurcation using awake fiberoptic intubation.
• General anesthesia was initiated uneventfully after securing the airway.
• Histological analysis revealed squamous cell carcinoma, suggesting malignancy-related necrosis as a potential cause.

Conclusions:

• Awake fiberoptic intubation is an effective technique for managing tracheal perforation following thyroid surgery.
• This case underscores the importance of considering advanced airway techniques for rare post-operative complications.
• Malignancy-related tracheal necrosis should be considered in the differential diagnosis of post-thyroidectomy tracheal perforations.