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      “Tracheomalacia after Thyroidectomy,” Does it Truly Exist?

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          Abstract

          Aim:

          Tracheomalacia is a potentially life-threatening, but a rare complication of thyroidectomy. In previous studies, the incidence rate was very different. Considering the relatively high prevalence of goiter and thyroidectomy in the West Azerbaijan region, we designed this study to determine the tracheomalacia incidence in patients who underwent thyroidectomy within a 10-year interval.

          Materials and Methods:

          This retrospective study was done in Urmia Imam Khomeini Hospital in West Azarbayjan Province. Demographic characteristics including the age and sex of patients who underwent thyroidectomy between 2007 and 2017 and also the incidence of tracheomalacia after surgery were recorded.

          Results:

          From 2007 to 2017, total 1236 thyroidectomy were performed. The patients’ age ranged from 15 to 83-year-old with a mean age of patients was 44.5 ± 13.81 years old. Two hundred and twenty-nine patients (19%) were male and 1007 (81%) were female. We did not find any cases of tracheomalacia after thyroidectomy in our study population.

          Conclusion:

          Based on the results of this study, it seems that with the necessary precautions, the incidence of tracheomalacia can reach zero.

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          Most cited references15

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          Evidence-based surgical management of substernal goiter.

          Derek G. Doherty, Halbert L. White, P. Gauger (2008)
          A number of reports have been published concerning the surgical treatment of substernal goiters; however, there is yet to be a comprehensive review of this body of literature using evidence-based methodology. This article is a systematic review of the literature using evidence-based criteria and a review of unpublished data from our institution. Issue 1. Limited level III/IV data suggest that the incidence of cancer in substernal goiters is not higher than the incidence of cancer in cervical goiters. Risk factors for malignancy in substernal goiters may include a family history of thyroid pathology, a history of cervical radiation therapy, recurrent goiter, and the presence of cervical adenopathy (grade C recommendation). Issue 2. Prospective level V data suggest that, for most patients, expert endocrine surgeons utilize an extracervical approach approximately 2% of the time to remove a substernal goiter safely; a sternotomy or thoracotomy appears more likely in cases of a primary substernal goiter or a mass larger than the thoracic inlet (no recommendation). Issue 3. There may be a higher rate of permanent hypoparathyroidism and unintentional permanent recurrent laryngeal nerve injury when total thyroidectomy is performed for removal of a substernal goiter than for removal of a cervical goiter alone (grade C recommendation). Injury of the external branch of the superior laryngeal nerve was not specifically addressed and is almost certainly underreported. Issue 4. The presence of a substernal goiter, especially being present more than 5 years and causing significant tracheal compression, is likely a risk factor for tracheomalacia and tracheostomy (grade C recommendation). Tracheomalacia with substernal goiter is an infrequent occurrence, and many cases of tracheomalacia can be managed without tracheostomy (no recommendation). Issue 5. Prospective level V data suggest that about 5% to 10% of operations for substernal goiters are performed because of recurrent or persistent disease, although retrospective level V data report an even higher rate, up to 37%. The most common initial operations with recurrence or persistence appear to be subtotal or hemithyroidectomy (no recommendation). Evidence-based recommendations provide reliable information regarding the pathologic findings and operative management of substernal goiters in expert hands.
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            Paediatric Tracheomalacia

            Erik B Hysinger, Howard Panitch (2016)
            Intrathoracic tracheomalacia is characterized by increased compliance of the central airway within the thorax. This leads to excessive dynamic collapse during exhalation or periods of increased intrathoracic pressure such as crying. Extrathoracic tracheomalacia involves dynamic collapse of the airway between the glottis and sternal notch that occurs during inhalation rather than exhalation. The tone of the posterior membrane of the trachea increases throughout development and childhood, as does the rigidity of the tracheal cartilage. Abnormalities of airway maturation result in congenital tracheomalacia. Acquired tracheomalacia occurs in the normally developed trachea due to trauma, external compression, or airway inflammation. Although tracheomalacia can be suspected by history, physical examination, and supportive radiographic findings, flexible fiberoptic bronchoscopy remains the "gold standard" for diagnosis. Current treatment strategies involve pharmacotherapy with cholinergic agents, positive pressure ventilation, and surgical repair.
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              Tracheomalacia.

              Christian Kugler, Franz Stanzel (2014)
              Tracheomalacia is excessive collapsibility of the trachea, typically during expiration. Congenital forms are associated with severe symptoms. Milder forms often present after the neonatal period. Adult malacia is mostly associated with chronic obstructive pulmonary disease. Functional bronchoscopy is still not standardized. Dynamic airway CT is a promising tool for noninvasive diagnosis. Bronchoscopy and stent insertion lead to significant improvement, but with a high complication rate. Surgical lateropexia, tracheal resection, and surgical external stabilization are options. Tracheoplasty seems to be the best choice for selected cases of adult malacia. The most commonly performed surgery in children is aortopexy.
              Article 0 comments Cited 9 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Niger J Surg
                Journal ID (iso-abbrev): Niger J Surg
                Journal ID (publisher-id): NJS
                Title: Nigerian Journal of Surgery : Official Publication of the Nigerian Surgical Research Society
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 1117-6806
                ISSN (Electronic): 2278-7100
                Publication date (Print): Jan-Jun 2020
                Publication date (Electronic): 10 February 2020
                Volume: 26
                Issue: 1
                Pages: 59-62
                Affiliations
                [1 ]Department of Endocrinology and Metabolism, Maternal and Childhood Obesity Research Center, Urmia University of Medical Sciences, Urmia, Iran
                [2 ]Department of Endocrinology and Metabolism, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
                [3 ]Department of General and Thoracic Surgery, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
                [4 ]Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
                [5 ]Student Research Committee, Faculty of Medical Sciences, Tabriz Branch, Islamic Azad University, Tabriz, Iran
                Author notes
                Address for correspondence: Dr. Seyed Arman Seyed Mokhtari, 15 Num, Susan Alley, Golha Street, Tabriz, Iran. E-mail: armanmxt@ 123456yahoo.com
                Article
                Publisher ID: NJS-26-59
                DOI: 10.4103/njs.NJS_31_19
                PMC ID: 7041345
                SO-VID: 4815d2c7-a32e-4054-b1e8-4d1300a3cd9b
                Copyright © Copyright: © 2020 Nigerian Journal of Surgery
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 13 July 2019
                Date accepted : 11 September 2019
                Categories
                Subject: Original Article

                Keywords: iran,thyroidectomy,tracheomalacia
                Data availability:
                Keywords: iran, thyroidectomy, tracheomalacia

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