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Case Reports
. 2019 May 17:27:100860.
doi: 10.1016/j.rmcr.2019.100860. eCollection 2019.

Combined tracheostomy and thyroidectomy in a patient with cervical spine fracture

Hugo Bonatti  1 , Kawther Elsouri  2 , Nasser Elsouri  2
Affiliations
Case Reports

Combined tracheostomy and thyroidectomy in a patient with cervical spine fracture

Hugo Bonatti et al. Respir Med Case Rep. .

Abstract

Background: Combined tracheostomy and thyroidectomy is usually done in case of removal of a large goiter causing damage to the tracheal wall. Thyroidectomy to get access to the trachea for surgical airway is a rare procedure. Tracheostomy following cervical spinal fracture is challenging as no hyperextension can be provided limiting exposure.

Case report: A 45-year-old intoxicated male with a head on bicycle accident suffered a C1 fracture and cervical spinal shock requiring emergent intubation. The C1 fracture was managed with a cervical collar. The patient improved neurologically on the ICU; however, he could not be weaned from mechanical ventilation thus requiring tracheostomy. On initial trauma CT-scan, a large goiter displacing the trachea to the left side was seen. He was kept in line stabilized using towels in the OR. A 5 cm transverse neck incision was made. The large partially retrosternal goiter reaching the aortic arch was stepwise mobilized out of the neck. The isthmus was divided; the enlarged right lobe was brought out of the neck and resected. The trachea was pulled to the midline, crosswise incised, the skin flaps were sutured down and a 7 Shiley cannula was inserted. A PEG tube was placed. The patient had a protracted course but ultimately was transferred alert and oriented to a long-term rehabilitation facility moving all extremities.

Conclusion: Combined thyroidectomy with tracheostomy in the setting of cervical fracture is technically challenging but was an essential step in the recovery of this patient.

Keywords: Cervical spine fracture; Spinal shock; Thyroidectomy; Tracheostomy.

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Figures

Fig. 1
Fig. 1
Trauma CT-scan: C1 fracture (arrows).
Fig. 2
Fig. 2
a/Chest x-ray showing large neck mass (arrows) b/CT-scan at admission (sagittal): large retrosternal goiter reaching level of the aortic arch (arrows). c,d,e/CT-scan at admission (transverse cuts at various levels): large goiter compressing trachea and displacing it to the left (arrow).
Fig. 3
Fig. 3
a/Intraoperative findings: Goiter delivered out of the neck incision (arrows) b/Specimen: large goiter.
See this image and copyright information in PMC

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