Post-thyroidectomy tracheocutaneous fistula; A case report with literature review

INTRODUCTION: Total thyroidectomy represents one of the commonest procedures performed for thyroid diseases. The aim of this paper is to report a rare case of tracheocutaneous fistula after total thyroidectomy. CASE REPORT: A 44-year-age female presented with left side neck swelling for 2 month duration. Neck ultrasound showed a well-defined left thyroid nodule (25 × 15 × 14 mm) with features highly suggestive of malignancy, under general anesthesia total thyroidectomy was performed. On the third postoperative day, the patient came back with neck swelling especially during speaking, there was subcutaneous emphysema, wound opened with residual air leak. Under local anesthesia, the wound opened, there was 10 × 10 mm opening in the anterior aspect of trachea, a tracheostomy was inserted, the patient was sent home after decannulation with an opening in the anterior neck. Twenty days later the tracheal opening closed spontaneously. DISCUSSION: The possibility of a tracheal wall ischemic necrosis is plausible due to cautery use. Some autopsy studies have demonstrated that small branches of inferior thyroid artery form the main blood supply of the upper segment of trachea. These fragile branches have a lateral entry point that can be damaged readily leading to ischemia and necrosis. CONCLUSION: Ischemic tracheal necrosis, although very rare, is possible after total thyroidectomy, minimal use of electro-cautery is advised whenever possible.