Intraoperatively diagnosed tracheal tear during a parathyroidec-tomy with previously undiagnosed tracheomalacia: a case report

Tracheal rupture is a rare complication of endotracheal intubation and surgery of thyroid gland. We present a case of tracheal rupture diagnosed and repaired intraoperatively. A 76-year-old female patient with a recurrent parathyroid adenoma and cold thyroid nodule was scheduled for a bilateral exploration of the parathyroid glands associated to thyroid lobectomy. Induction of anesthesia was uncomplicated. Orotracheal intubation was easy and atraumatic using a 6.5 mm EMG endotracheal tube (ETT) with low pressure cuff. Approximately 30 minutes after begining surgery, a tracheal tear was suspected by the anesthesiologist warned by his respiratory monitoring alarms (leakage in the ventilatory system). After confirming the diagnosis, a suture was performed and antibiotic coverage was administrated. The patient made a slight cervical subcutaneous emphysema and fully recovered after four weeks without any other complication. We review the litterature and discuss the risk factors of tracheal tear during thryroidectomy surgery and endotracheal intubation