Vol 8 | Issue 1 | January-April 2022 | Page: 09-11 | Neha Panse, Poonam Ghodki, Musfarah An Um Anasuddin Farooqui
Author: Neha Panse , Poonam Ghodki , Musfarah An Um Anasuddin Farooqui 
 Department of Anaesthesia, Smt. Kashibai Navale Medical College & General Hospital, Pune, Maharashtra, India.
Address of Correspondence
Dr. Musfarah An Um Anasuddin Farooqui
Department of Anaesthesia, Smt. Kashibai Navale Medical College & General Hospital, Pune, Maharashtra, India.
Introduction: Vocal cord palsy after thyroid surgeries is a known complication. Most common cause is intraoperative iatrogenic injury to recurrent laryngeal nerve (RLN). Careful intraoperative dissection and identification of the complication in the immediate postoperative period can prevent grave consequences. Delayed presentation of vocal cord palsy is known but delay up to one month and patient surviving with symptoms for one year is extremely rare. Several theories have been postulated regarding survival.
Case report: We report a case of a middle aged female who first developed subcutaneous emphysema following thyroidectomy and then presented with recurrent complaints of dyspnoea and stridor for about a year, later diagnosed to have bilateral RLN injury, managed with tracheostomy twice and subsequently treated with laser cordectomy.
Conclusion: Tracheomalacia should be suspected in all long standing goitres. RLN palsy generally, an intraoperative complication should be assessed thoroughly in immediate post- operative period to improve the outcome of every thyroid surgery. Delayed palsies may be difficult to assess and diagnose and should be ruled out. Prevention is always better than cure: hence wherever possible an intraoperative nerve monitoring should be done.
Keywords: Recurrent laryngeal nerve, Subcutaneous emphysema, Thyroidectomy tracheostomy, Vocal cord palsy
1. Morin RJ, Swan KG, Tan V. Acute forearm compartment syndrome secondary to local arterial injury after penetrating trauma. J Trauma. 2009;66:989-93.
2. Vadhanan P, Tripaty DK, Adinarayanan S. Physiollogical and pharmacologic aspects of peripheral nerve blocks. J Anaesthesiol Clin Pharmacol. 2015;31(3):384–93.
3. Klucka J, Stourac P, Stouracova A, Masek M, Repko M. Compartment syndrome and regional anaesthesia: Critical review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2017;161(3):242–51.
4. Li J, Karmakar MK, Li X, Kwok WH, Ngan Kee WD. Regional hemodynamic changes after an axillary brachial plexus block: a pulsed-wave Doppler ultrasound study. Reg Anesth Pain Med. 2012;37:111-8.
5. Bosselmann T, Kolbenschlag J, Goertz O, Zahn P, Prantl L, Lehnhardt M, et al. Improvement of Superficial and Deep Cutaneous Microcirculation Due to Axillary Plexus Anesthesia Impaired by Smoking. J Clin Med. 2021;10(10):2114.
6. Fredrickson MJ, Wolstencroft P, Kejriwal R, Yoon A, Boland M, Chinchanwala S. Single versus triple injection ultrasound-guided infraclavicular block: confirmation of the effectiveness of the single injection technique. Anesth Analg. 2010;111:1325-27.
7. Nathanson MH, Harrop-Griffiths W, Aldington DJ, Forward D, Mannion S, Kinnear-Mellor RGM, et al. Regional analgesia for lower leg trauma and the risk of acute compartment syndrome: Guideline from the Association of Anaesthetists. Anaesthesia. 2021.
8. Duckworth AD, McQueen MM. The diagnosis of acute compartment syndrome: a critical analysis review. JBJS Rev. 2017;5(12):e1.
9. Mannion S, Capdevila X. Acute compartment syndrome and the role of regional anesthesia. Int. Anesthesiol Clin. 2010;48(4):85-105.
10. Ulmer T. The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder? J Orthop Trauma. 2002;16(8):572-7.
11. Driscoll EB, Maleki AH, Jahromi L, Nelson Hermecz B, Nelson LE, Vetter IL, et al. Regional anesthesia or patient-controlled analgesia and compartment syndrome in orthopaedic surgical procedures: a systemic review. Local Reg Anest. 2016;9:65–81.
12. Kucera TJ, Boezaart AP. Regional anesthesia does not consistently block ischemic pain: two further cases and a review of the literature. Pain Med. 2014;15(2):316–19.
13. Frolich MA, Deshpande H, Ness T, Deutsch G. Quantitative changes in regional cerebral blood flow induced by cold, heat and ischemic pain: a continuous arterial spin labeling study. Anesthesiology. 2012;117:857–67.
14. Sellei RM, Warkotsch U, Kobbe, Weber CD, Reinhardt N, De La Fuente M, et al. Non-invasive and reliable assessment of compartment elasticity by pressure related ultrasound: An in-vitro study. Injury. 2021;52(4):724-30.
|How to Cite this Article: Panse N, Ghodki P, Farooqui M | A Rare Case of Longstanding Complication Following a Total Thyroidectomy: An Incident Reporting | Journal of Anaesthesia and Critical Care Case Reports | January-April 2022; 8(1): 09-11.|