Tracheomalacia after reoperation for an adenomatous goiter located in a unique position |
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Authors: | Yosuke Nakadate Taeko Fukuda Hisato Hara Makoto Tanaka |
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Institution: | (1) Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimogato, Chuo Yamanashi, 409-3898, Japan;(2) Department of Anesthesiology, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, Tsukuba University, 1-1-1 Tennodai, Tsukuba City Ibaraki, 305-8575, Japan;(3) Department of Breast Thyroid Endocrine Surgery, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, Tsukuba University, 1-1-1 Tennodai, Tsukuba City Ibaraki, 305-8575, Japan; |
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Abstract: | Tracheomalacia after thyroidectomy is a life-threatening situation. However, it is difficult to predict postoperative tracheal
obstruction with certainty. A case of a 74-year-old woman with a long-standing adenomatous goiter (98 g) is reported. She
had undergone partial right lobe thyroidectomy 54 years earlier. After total thyroidectomy, she was reintubated and required
a tracheostomy because of tracheomalacia. The right residual thyroid tumor weighed only 5 g, but it extended to the retrotracheal
space. Because the right lobe had stretched the membranous wall of the trachea over a long period of time, the tracheal lumen
was thought to have collapsed because of loss of the foundation of the tracheal cartilage (the residual right lobe) along
with the supportive surrounding tissue (the left lobe) after surgery. The present case suggests that the occurrence of tracheomalacia
could be attributed to reoperation and retrotracheal extension. Thus far, six preoperative predictive factors for the development
of severe postoperative respiratory obstruction have been reported: goiter for more than 5 years, preoperative recurrent laryngeal
nerve palsy, significant tracheal narrowing and/or deviation, retrosternal extension, difficult endotracheal intubation, and
thyroid cancer. Two more factors, reoperation and retrotracheal extension of tumor, may also be risks for airway obstruction
after thyroidectomy. |
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