ENDOTRACHEAL STENT IN A CASE OF SEVERE TRACHEAL STENOSIS FROM RELAPSING GOITER

Abstract

Objectives:The surgical approach for tracheal complications in thyroidectomy sometimes requires tracheotomy in urgency for supporting the airways flow (especially in presence of giant goiter). Nevertheless, tracheotomy, even if necessary to guarantee the restoration of respiratory function, it can not be considered as definitive therapy in presence of alterations of trachea (i.e. stenosis) susceptible to heal. An useful help in clinical management comes by tracheal prosthesis as we showed in a case of a giant relapsing multinodular goiter. Materials and methods: A 72 yr old woman, affected by giant relapsing goiter rapidly growing, came to our observation with severe orthopnea, due to stenosis and lateral shifting of trachea because of the pushing of the thyroid gland as showed from CT scan. She underwent to tracheotomy in order to have the control of her airways (the goiter was initially suspected to be an anaplastic carcinoma of thyroid and then recognized as multinodular goitre at histological finding. Following thyroidectomy, the dispnea became more severe due to the presence of tracheostenosis. In order to treat the persistent tracheal stenosis it was decided the insertion of a “T” shaped Montgomery tube. Thereafter T prosthesis was changed after 1 months with a silicon studded tracheal stent and tracheal window closed. Past 3 months the stent was removed. Results: Shortly after the insertion of tracheal stent the dispnea ceased and the stent remotion was followed by a complete restoration of patient's respiratory and vocal function. Conclusions: The use of endotracheal silicon stents of different shape, caliber and length helps the surgeon to manage difficult cases in which a giant goiter causes a grave stenosis. The stent is therefore an useful tool as a bridge support to treat tracheal strictures waiting for its healing, permitting to the patients a good quality of life.