Needle tracheostomy for acute upper airway obstruction

Coping with respiratory obstruction after thyroidectomy for giant goitres in northern Nigeria

Thyroidectomy for giant goitres in Northern Nigeria is associated with a high incidence of postoperative asphyxia. Tracheostomy may be a life saving procedure in these circumstances, but delay may prove fatal when its need arises insidiously. It is therefore better established prophylactically in patients who are more than likely to develop asphyxia, as in the case of preoperative complications followed by prolonged surgery. During the dry, dust-laden and desiccating Harmattan season of Northern Nigeria, however, tracheostomy poses life-threatening dangers and should be established only in patients who need it for survival. Postoperative asphyxia can be minimised by adopting certain operative techniques which reduce the risks of postoperative haematoma and laryngeal oedema. Establishment of a thyroidectomy team for surgery and for postoperative management improves results.

Cecil Joll Lecture, 1979. Respiratory obstruction in thyroid surgery

The causes of respiratory obstruction before, during, and after thyroid surgery are outlined and their clinical features described. The dangers of postoperative respiratory obstruction are emphasised and the measures necessary to prevent it if possible, to anticipate it, and treat it are discussed in detail.

Tracheal collapse after thyroidectomy

Tracheal collapse after thyroidectomy is uncommon; when it occurs, complete airway obstruction is often sudden, unexpected and fatal. In this paper a patient treated for tracheal collapse by tracheostomy and followed up for 1 year is described and, from a review of the literature, a further 9 cases are presented. The aetiology of the condition, the patient at risk and the technique of management are discussed.