Tiroid cerrahisi esnasýnda endotrakeal tüp kafýna baðlý geliþen membranöz trakeal rüptürün yönetimi

Trakeobronþiyal rüptür son derece dramatik ve yaþamý tehdit edici olabilir ve orotrakeal entübasyon sonrasý yaklaþýk 100.000 vakanýn 5'inde görülür. Entübasyon, trakeostomi ve bronkoskopi sonucunda meydana gelebilir. Bu olgu sunumunda 27 yýl önce bir tiroid cerrahisi geçirmiþ olan ve kliniðimize nüks multinodüler guatr sebebiyle baþvuran 56 yaþýnda bir kadýn hastayý sunduk. Aralýklý intraoperatif sinir monitorizasyonu eþliðinde tamamlayýcý tiroidektomi operasyonu komplikasyonsuz olarak uygulanan hastada hemostaz sonrasýnda, olasý rezidü tiroid dokusu ve santral kompartmanlarda olasý patolojik lenf nodlarýnýn parmak palpasyonu ile aranmasýný içeren son kontroller sýrasýnda solda daha belirgin olmak üzere trakeanýn her iki posterolateralinde rezidü tiroid dokusu olduðundan þüphe edilen lastik kývamýnda kitle yapýsý palpe edildi. Palpe edilen kitlenin endotrakeal tüpün kafý olabileceði düþünülerek anestezi ekibinden endotrakeal tüp manþon basýncýnýn düþürülmesi istendi ve manþon basýncýnýn düþürülmesiyle birlikte palpe edilen kitlenin küçüldüðü gözlendi. Endotrakeal tüp manþonunun neden olduðu membranöz trakeal rüptür sütürlerle kapatýldý ve üzerine superior bazlý strap kas fleb ile rekonstrüksiyon uygulandý. Hasta 7. gün saðlýkla taburcu edildi. Tiroid cerrahisi ile uðraþan cerrahlar tarafýndan ameliyat sonunda yapýlacak basit bir rutin dijital muayene bu tür yaralanmalarýn meydana geldiði durumlarda erken onarýma izin vereceði için prognoza olumlu katkýda bulunacaktýr.

Management of membranous tracheal rupture due to the endotracheal tube cuff during thyroid surgery

Tracheobronchial ruptures can be extremely dramatic and life threatening and are encountered in approximately 5 out of 100,000 cases after orotracheal intubation. They can occur as a result of intubation, tracheostomy, and bronchoscopy. In this case report, we presented a 56-year-old female patient with a history of thyroid surgery 27 years prior who presented to our clinic with recurrent multinodular goiter. The patient underwent a complementary complication-free thyroidectomy assisted by intermittent intraoperative nerve monitoring. After hemostasis, final controls involving digital palpation of the possible remnants of the thyroid gland and a search for pathological lymph nodes in the central compartments, a mass structure with a rubbery consistency suspicious for residue thyroid tissue was palpated in both posterolateral aspects of the trachea, but more prominently in the left. The anesthesia team was asked to decrease the cuff pressure, assuming that the palpated mass could be the cuff of the endotracheal tube, and the mass was noted to shrink. The membranous tracheal rupture due to the endotracheal tube cuff was closed with sutures running superiorly, and a superiorly based strap muscle flap was placed over during thyroid surgery. The patient was discharged on day 7. A simple routine digital examination by the attending surgeon dealing with the thyroid surgery would contribute favorably to prognosis, as such a precaution would allow early repair in cases where such injuries occur.