Advertisement

World Journal of Surgery

, Volume 31, Issue 4, pp 832–837 | Cite as

High Incidence of Tracheomalacia in Longstanding Goiters: Experience from an Endemic Goiter Region

  • Amit Agarwal
  • Anand K. Mishra
  • Sushil K. Gupta
  • Farah Arshad
  • Anil Agarwal
  • M. Tripathi
  • P. K. Singh
Article

Abstract

Background

Our institute caters to a large number of patients with large, longstanding multinodular goiters; tracheal deviation and resulting airway problems like tracheomalacia are relatively common. However, the literature is sparse on the criteria of early diagnosis and optimum management of tracheomalacia, which our study highlights.

Methods

This retrospective study analyzed 900 thyroidectomies carried out during 1990–2005 for which data from 28 patients treated for tracheomalacia after thyroidectomy were available for analysis. Criteria for making a diagnosis of tracheomalacia after thyroidectomy included one or more of the following: normal vocal cord mobility, absence of glottic or subglottic edema or hematoma, soft and floppy trachea on palpation, obstruction to spontaneous respiration on gradual withdrawal of the endotracheal tube.

Results

Mean duration of thyroid enlargement was 13.75 years. Only 7 patients had a history of stridor. Tracheostomy was performed in 26 patients, and 2 patients were put on prolonged intubation. Tracheostomy was performed in 18 patients on the operating table, and 8 in the recovery room. The mean weight of the gland was 442 g and histopathology revealed that 11 cases were benign goiter. The tracheostomy tube was removed after an average of 8.5 days. There were no cases of tracheal stenosis on long-term follow-up.

Conclusions

Patients with longstanding goiter, even when benign, are more prone to develop tracheomalacia. On the basis of our experience we strongly advocate tracheostomy intraoperatively if the trachea is soft and floppy and/or collapse of the trachea is observed following gradual withdrawal of the endotracheal tube.

Keywords

Goiter Multinodular Goiter Tracheostomy Tube Tracheal Stenosis Prolonged Intubation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Sitges-Serra A, Sancho J. Surgical management of recurrent and intrathoracic goiter. In Clark O, Duh Q-Y, Kebebew E, editors, Textbook of Endocrine Surgery, Philadelphia, W.B. Saunders Company, 1997Google Scholar
  2. 2.
    Green WE, Shepperd HW, Stevenson HM, et al. Tracheal collapse after thyroidectomy. Br J Surg 1979;66:554PubMedCrossRefGoogle Scholar
  3. 3.
    Peterson JL, Rovenstine EA. Tracheal collapse complicating thyroidectomy: a case report. Curr Res Anesth Analg 1936;15:300Google Scholar
  4. 4.
    Singh B, Lucente FE, Shaha AR. Substernal goiter: a clinical review. Am J Otolaryngol 1994;15:409PubMedCrossRefGoogle Scholar
  5. 5.
    Shin J, Randolph GW, Grillo H. Surgery for cervical and substernal goiter in 200 patients at Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital. Laryngoscope (submitted)Google Scholar
  6. 6.
    Jokinen K, Palva T, Sutinen S, Nuutinen J. Acquired tracheo-broncho-malacia. Ann Clin Res 1977;9:52–57PubMedGoogle Scholar
  7. 7.
    Johnson TH, Mikita JJ, Wilson RJ, Feist JH. Acquired tracheomalacia. Diagn Radiol 1973;109:577–580Google Scholar
  8. 8.
    Conacher ID. Anaesthesia for Thoracic and Pulmonary Surgery. In Prys-Roberts C, Brown Br Jr, Eds., Butterworth Heinemann, 1936;15:300Google Scholar
  9. 9.
    McHenry CR, Piotrowsi. Thyroidectomy in patients with marked thyroid enlargement: airway management, morbidity, and outcome. Am Surg 1994;60:586–591Google Scholar
  10. 10.
    Shaha A, Alfonso A, Jaffe BM. Acute airway distress due to thyroid pathology. Surgery 1987;102:1068–1074PubMedGoogle Scholar
  11. 11.
    Green WER, Shepperd HWH, Stevenson HM, et al. Tracheal collapse after thyroidectomy. Br J Surg 1979;66:554–557PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • Amit Agarwal
    • 1
  • Anand K. Mishra
    • 1
  • Sushil K. Gupta
    • 2
  • Farah Arshad
    • 1
  • Anil Agarwal
    • 3
  • M. Tripathi
    • 3
  • P. K. Singh
    • 3
  1. 1.Department of Endocrine SurgerySanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia
  2. 2.Department of EndocrinologySanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia
  3. 3.Department of AnaesthesiaSanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia

Personalised recommendations