Combined tracheostomy and thyroidectomy in a patient with cervical spine fracture

Combined tracheostomy and thyroidectomy in a patient with cervical spine fracture

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Background: Combined tracheostomy and thyroidectomy is usually done in case of Drinks 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 Kone Kettle 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.