Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
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.

PubMed Disclaimer

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

References

    1. ElBashier E.M., Hassan Widtalla A.B., ElMakki Ahmed M. Tracheostomy with thyroidectomy: indications, management and outcome: a prospective study. Int. J. Surg. 2008 Apr;6(2):147–150. - PubMed
    2. ElBashier EM, Hassan Widtalla AB, ElMakki Ahmed M. Tracheostomy with thyroidectomy: indications, management and outcome: a prospective study. Int J Surg. 2008 Apr;6(2):147-150. - PubMed
    1. Pisano G., Canu G.L., Erdas E., Medas F., Calo P.G. Tracheostomy after total thyroidectomy: indications and results in a series of 3214 operations. Minerva Chir. 2019 June;74(3):277–278. - PubMed
    2. Pisano G, Canu GL, Erdas E, Medas F, Calo PG. Tracheostomy after total thyroidectomy: indications and results in a series of 3214 operations. Minerva Chir. 2019 Jan 18. - PubMed
    1. Shaha A.R., Burnett C., Alfonso A., Jaffe B.M. Goiters and airway problems. Am. J. Surg. 1989 Oct;158(4):378–380. discussion 80-1. - PubMed
    2. Shaha AR, Burnett C, Alfonso A, Jaffe BM. Goiters and airway problems. Am J Surg. 1989 Oct;158(4):378-380; discussion 80-1. - PubMed
    1. Agarwal A., Mishra A.K., Gupta S.K., Arshad F., Tripathi M., Singh P.K. High incidence of tracheomalacia in longstanding goiters: experience from an endemic goiter region. World J. Surg. 2007 Apr;31(4):832–837. - PubMed
    2. Agarwal A, Mishra AK, Gupta SK, Arshad F, Tripathi M, Singh PK. High incidence of tracheomalacia in longstanding goiters: experience from an endemic goiter region. World J Surg. 2007 Apr;31(4):832-837. - PubMed
    1. Avenia N., Vannucci J., Monacelli M., Lucchini R., Polistena A., Santoprete S. Thyroid cancer invading the airway: diagnosis and management. Int. J. Surg. 2016 Apr;28(Suppl 1):S75–S78. - PubMed
    2. Avenia N, Vannucci J, Monacelli M, Lucchini R, Polistena A, Santoprete S, et al. Thyroid cancer invading the airway: diagnosis and management. Int J Surg. 2016 Apr;28 Suppl 1:S75-S78. - PubMed

Publication types

LinkOut - more resources