Combined tracheostomy and thyroidectomy in a patient with cervical spine fracture.

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.