thyroidectomy. The pat had longstanding goiter for which he had the surgery. What is the most
likely dx?
a. Thyroid storm
b. Hematoma
c. Unilateral recurrent laryngeal nerve injury
d. External laryngeal nerve injury
e. Tracheomalacia
answer E
Tracheomalacia is a process characterized by flaccidity of the supporting tracheal cartilage, widening of the posterior membranous wall, and reduced anterior-posterior airway caliber. These factors cause tracheal collapse, especially during times of increased airflow, such as coughing, crying, or feeding.
Tracheomalacia most commonly affects the distal third of the trachea and can be associated with various congenital anomalies, including cardiovascular defects, developmental delay, gastroesophageal reflux, and tracheoesophageal fistula.
Tracheomalacia can be categorized into three groups on the basis of histologic, endoscopic, and clinical presentation, as follows:
-
Type I presents as congenital or intrinsic tracheal abnormalities that can be associated with a tracheoesophageal fistula or esophageal atresia
-
Type II presents as extrinsic defects or anomalies, such as a vascular ring causing undue pressure on the trachea
-
Type III presents as acquired tracheomalacia that occurs with prolonged intubation, chronic tracheal infections, or inflammatory conditions like relapsing polychondritis
Recurrent laryngeal nerve injury
-unilateral: hoarseness or asymptomatic due to compensation from the other side
-bilateral: aphonia, air way narrowing
External laryngeal nerve injury
- weakness of voice
What is a Thyroid crisis?
An acute exacerbation of hyperthyroidism seen
immediately postoperatively is now extremely
rare because of the careful preoperative preparation
of these patients. It is, however, a frightening
phenomenon with mania, hyperpyrexia and
marked tachycardia, which may lead to death
from heart failure. The cause is not fully understood,
but it may be due to a massive release of
thyroxine from the hyperactive gland during the
operation.
Complications of thyroidectomy
1 Hormonal :
a paraesthesiae, owing to coincidental
parathyroid removal or bruising;
b tetany (parathyroid removal or bruising);
c thyroid crisis;
d hypothyroidism, owing to extensive removal
of thyroid tissue;
e late recurrence of hyperthyroidism owing to
inadequate excision of the hyperthyroid
gland.
2 Damage to related anatomical structures :
a recurrent laryngeal nerve;
b injury to trachea;
c pneumothorax.
3 The complications of any operation, especially :
a haemorrhage;
b sepsis;
c postoperative chest infection;
d hypertrophic scarring (keloid).
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