High Incidence. of. Tracheomalacia

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Presentation transcript:

High Incidence. of. Tracheomalacia High Incidence of Tracheomalacia in Longstanding Goiters (A case report) Dr.J.Edward Johnson M.D.

Longstanding Goiter (20 yrs )

Longstanding Goiter (20 yrs )

Case History Long standing goitre – 15yrs No history of airway obstruction or vocal cord palsy TFT normal X-Ray neck & CT neck – no compression & only slight Rt side deviation of trachea DL scopy – vocal cords normal Anaemic with mild cardiomegaly(Hb 9 gms%)

X- RAY NECK (AP view)

X- RAY NECK (Lateral view)

CT SCAN

Air way assessment Mallampatti -class II Anticipated difficult air way because of huge goitre almost occupying whole neck

NO DIFFICULT INTUBATION (surprisingly) For video follow the link; http://www.youtube.com/watch?v=8wYZFZOf5uw

SIZE OF THE GLAND

POST OPERATIVE COMPLICATION Trachemalacia – noted 3Hrs after surgery Intubated with 7 size ETT cuffed Large dose steroids given Trial extubation tried after 36Hrs. Patient went for stridor once again and re-intubated with 6 size ETT cuffed. Tracheostimy done after 2 Hrs.

POST OPERATIVE TRACHEOMALACIA Incidence (Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, 226 014 Lucknow, India) - 1990–2005 - 28 patients treated for tracheomalacia -Mean duration of thyroid enlargement - 13.75 years -7 patients had a history of stridor -Tracheostomy was performed in 26 patients 18 patients on the operating table -The tracheostomy tube was removed after an average of 8.5 days.

TAKE HOME MESSAGE 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.