Can't Intubate, Can't Oxygenate Airway Failure Due to Post-thyroidectomy Cervical Hematoma: A Case Report

Post-thyroidectomy cervical hematoma is an uncommon but potentially fatal complication that may rapidly progress to life-threatening airway obstruction. We report the case of a 49-year-old woman who developed severe respiratory distress, marked cyanosis, and loss of responsiveness approximately four hours after total thyroidectomy with central compartment neck dissection. Immediate bedside wound opening and hematoma evacuation were performed, but adequate oxygenation was not restored. Two attempts at tracheal intubation using direct laryngoscopy were unsuccessful because severe upper-airway edema and anatomical distortion prevented visualization of the glottis. Given the persistent failure of oxygenation and extreme urgency of the situation, emergency front-of-neck access was undertaken without further attempts at tracheal intubation. An emergency surgical tracheotomy was performed through the already opened thyroidectomy field, enabling effective ventilation. Subsequent surgical exploration identified active bleeding in the region of the previously ligated left superior thyroid artery, which was successfully controlled, and the emergency airway was converted to a formal tracheostomy. The patient recovered without residual airway-related complications and was discharged on postoperative day seven. This case emphasizes that bedside wound decompression may be insufficient once advanced upper-airway edema has developed and highlights the need for prompt escalation to emergency front-of-neck access when adequate oxygenation cannot be restored and tracheal intubation is unsuccessful.