title: Management of a patient with tracheomalacia and supraglottic obstruction after thyroid surgery.
abstract: OBJECTIVE
  We describe an unusual combination of dynamic supraglottic, glottic, subglottic, and intrathoracic airway obstructions following a total thyroidectomy. These problems were anticipated, documented videographically, and managed preemptively.
  
  
  METHODS
  Following a total thyroidectomy, we replaced the endotracheal tube with a laryngeal mask airway, namely, the LMA-Classic™, in a patient with symptomatic tracheal compression and probable obstructive sleep apnea. Spontaneous ventilation was observed bronchoscopically through the LMA-Classic. Supraglottic swelling, extraglottic collapse on inspiration, and intrathoracic collapse on expiration were documented prior to recovery. These observations were of sufficient concern to warrant reinsertion of the endotracheal tube and subsequent tracheal extubation over a tube exchanger. Thereafter, we provided face-mask continuous positive airway pressure using a Boussignac mask with an endotracheal ventilation catheter in situ.
  
  
  CONCLUSIONS
  Acute airway collapse following thyroid surgery is a rare and potentially serious complication. Diagnosis by conventional methods may be insensitive. Difficulties may not be apparent until the patient becomes distressed after tracheal extubation, and this circumstance will worsen airway compromise. In such a state, re-establishing the airway can become life-threatening. We describe the preemptive identification, physiologic manifestations, and management of the supraglottic and subglottic obstruction exemplified by this case.
authors.affiliation: Department of Anesthesia, University of Toronto, Toronto, ON, Canada.
authors.forename: Corina
authors.initials: C
authors.lastname: Lee
authors.forename: Richard M
authors.initials: RM
authors.lastname: Cooper
authors.forename: David
authors.initials: D
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000209:etiology / Q000628:therapy*; D045422:Continuous Positive Airway Pressure; D005931:Glottis; D006042:Goiter / Q000601:surgery*; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D013965:Thyroidectomy / Q000009:adverse effects*; D055090:Tracheomalacia / Q000209:etiology / Q000628:therapy*