engleski

Huge multinodular goitre with mid tracheal obstruction:indication for fiberoptic intubation

Goitre or thyreomegaly is one of the most frequent causes of mid tracheal obstruction (external compression or stenosis) where di#cult degree of larynx visualization and/or di#cult airway management may be presented, depending on goitre’s size, type and ingrowth into surrounding tissue. Iodine de$cit disorders is still one of the most frequently cause of goitre in population in the Africa continent. Mostly of the patients with goitre are able to visit medical sta% at an advanced stage of disease. Mallampati test, thyreo-mental distance and interincisor gap appear to provide the optimal combination in prediction of di#cult visualization of larynx. Video laryngoscopy examination of subglottic region and inspection of tracheal deviation in presence of tracheal compression, without detected stenosis of trachea is standard and preferred technique in comparison with direct laryngoscopy. Intubation could be performed when vocal chords are visualized. The major di#culty of intubation in presented only in 5.3% of patients with goitre. Large goitre could not be always associated with higher incidences of di#cult endotracheal intubation. Predicting factors for di#cult airway assessment in these patients were only two: cancerous goitre (specially, if compressive signs are present) and Cormack and Lehane grade III/IV. Indication for $beroptic intubation is presented by tracheal compression or initial tracheal stenosis. Conventional tracheostomy have to be made in goitre’s patients whit identi$ed tracheomalacia and/or high degree or tracheal stenosis.

Goitre; tracheal obstruction; fiberoptic intubation

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