Tracheal Injury

The aim of this chapter is to describe the different conditions leading to a tracheal injury with a focus on those occurring in the clinical setting of thyroid surgery. Tracheal injury can be classified as traumatic or iatrogenic occurring during surgery, endotracheal intubation, or bronchoscopy. Tracheal damage is a rare complication of thyroidectomy and is more frequently observed in advanced thyroid cancer invading the airways. Respiratory distress, mediastinitis and sepsis are the most critical consequences. Early diagnosis and appropriate treatment are of paramount importance to prevent a fatal outcome or severe clinical sequelae. Two options for management can be considered: operative or non-operative. The choice of the most appropriate treatment is determined by the patient’s respiratory condition and the local extent of the injury. Non-operative management may be a safe option in patients with uncomplicated ventilation, superficial or sufficiently covered tears, moderate and non-progressive subcutaneous emphysema. A nonoperative approach includes tracheal bridging with ventilation tube, stent placement, or endoluminal repair. Surgical repair is the option of choice in those patients with larger injuries which require mechanical ventilation.