1 Department of Otolaryngology – Head and Neck Surgery, West Virginia University – School of Medicine, Morgantown, WV, USA
Thyroidectomy is a relatively common procedure with a low risk of serious complications. An unusual case of repeated delayed tracheal rupture after thyroidectomy is reported. A 38 year old female was transferred to our institution 10 days after thyroidectomy and 5 days after initial repair of tracheal rupture with a sternocleidomastoid (SCM) muscle flap. She presented to the transferring facility with shortness of breath, neck swelling and incisional drainage that started after a coughing episode. CT imaging performed at that time demonstrated diffuse subcutaneous emphysema throughout the neck, face and upper thorax. Pneumomediastinum and subpleural gas were present as well as a fluid collection in the thyroid bed. After initial evaluation by our service, she was taken to the operating room for drainage and repair. The previous SCM flap was found to be necrotic and was debrided. A 1 cm defect was identified at the lateral tracheal wall and closed primarily. Residual healthy SCM was secured over the closure. There was some residual air leak postoperatively which was ultimately resolved with several days of strict voice rest and pressure.
As a rare complication of thyroidectomy, there is little literature regarding the management of delayed tracheal rupture. Our rationale for the management of this patient, as well as theories regarding the failure of the initial repair will be disussed.
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