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

2. Longstanding Goiter (20 yrs )

3. Longstanding Goiter (20 yrs )

4. 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%)

5. X- RAY NECK (AP view)

6. X- RAY NECK (Lateral view)

7. CT SCAN

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

9. NO DIFFICULT INTUBATION (surprisingly)
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10. SIZE OF THE GLAND

11. 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.

12. POST OPERATIVE TRACHEOMALACIA
Incidence (Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road,  Lucknow, India) – patients treated for tracheomalacia Mean duration of thyroid enlargement 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 days.

13. 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.