Combined tracheostomy and thyroidectomy in a patient with cervical spine fracture

• Main Authors: Hugo Bonatti, Kawther Elsouri, Nasser Elsouri
• Format: Article
• Language: English
• Published: Elsevier 2019-01-01
• Series: Respiratory Medicine Case Reports
• Online Access: http://www.sciencedirect.com/science/article/pii/S2213007119301133

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