Thyroid Surgery
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Surgery Essay
Discuss the possible compilations of thyroid surgery. There are three types of complications in thyroid surgery: complications in the operating theatre itself, problems with analgesia, and problems specific to the thyroidectomy itself. The dangers to the patient in the operating theatre include: bruising and burns with diathermy and alcohol. There might also be complications due to anaesthesia. The positioning of the patient during thyroid surgery is with a fully extended neck. This can cause problems during intubation and extubation such as tracheal collapse. Post thyroid surgery, haemorrhage may occur, which can compress structures in the thoracic inlet, leading to venous engorgement, tracheal compression and asphyxia. The wound must be reopened urgently and the patient intubated and taken back to theatre for exploration of wound, removal of haematoma and control of bleeding. The external branch of the superior laryngeal nerve may be damaged during ligation of the vascular pedicle at the superior lobe. Inability to tense the vocal cord results in a weak, hoarse voice. The mucous membrane of the upper larynx, which is supplied by this nerve is anesthetised and it makes entry of foreign bodies easier. Damage to the recurrent laryngeal nerve is more serious. Bruising of this nerve causes temporary paralysis in the vocal cord, but recovery within 3 1
Surgery Essay
months is usual. Division of the nerve causes paralysis of the vocal cords midway between closed and open. The normal cord on the other side usually compensates by crossing over in phonation. Some degree of stridor may be evident on exertion. Bilateral nerve injury causes stridor and ineffective coughing when the endotracheal tube is withdrawn after the operation. In this case the tube is reinserted and if there is no improvement tracheostomy may be required. Bruising or removal of the parathyroid glands leads to hypocalcaemia and symptoms of increase neuromuscular excitability. Chvostek’s sign is positive, when the facial nerve is tapped over the parotid gland. Calcium levels are always checked post-operatively and if it is less than 2.0mmol/l, calcium supplements are required. The patient may recover, if not the patient should be treated throughout his lifetime. Although rare, due to improved pre-conditioning of patients prior to surgery for thyrotoxic conditions, acute thyrotoxic crises are possible. It may occur due to handling of the gland. Features include sweating, fever, tachycardia and hypertension. Lastly, the scar can become hypertrophic or keloid, especially when the incision has been placed low in the neck. 20/01/09
2
Discuss the possible compilations of thyroid surgery. There are three types of complications in thyroid surgery: complications in the operating theatre itself, problems with analgesia, and problems specific to the thyroidectomy itself. The dangers to the patient in the operating theatre include: bruising and burns with diathermy and alcohol. There might also be complications due to anaesthesia. The positioning of the patient during thyroid surgery is with a fully extended neck. This can cause problems during intubation and extubation such as tracheal collapse. Post thyroid surgery, haemorrhage may occur, which can compress structures in the thoracic inlet, leading to venous engorgement, tracheal compression and asphyxia. The wound must be reopened urgently and the patient intubated and taken back to theatre for exploration of wound, removal of haematoma and control of bleeding. The external branch of the superior laryngeal nerve may be damaged during ligation of the vascular pedicle at the superior lobe. Inability to tense the vocal cord results in a weak, hoarse voice. The mucous membrane of the upper larynx, which is supplied by this nerve is anesthetised and it makes entry of foreign bodies easier. Damage to the recurrent laryngeal nerve is more serious. Bruising of this nerve causes temporary paralysis in the vocal cord, but recovery within 3 1
Surgery Essay
months is usual. Division of the nerve causes paralysis of the vocal cords midway between closed and open. The normal cord on the other side usually compensates by crossing over in phonation. Some degree of stridor may be evident on exertion. Bilateral nerve injury causes stridor and ineffective coughing when the endotracheal tube is withdrawn after the operation. In this case the tube is reinserted and if there is no improvement tracheostomy may be required. Bruising or removal of the parathyroid glands leads to hypocalcaemia and symptoms of increase neuromuscular excitability. Chvostek’s sign is positive, when the facial nerve is tapped over the parotid gland. Calcium levels are always checked post-operatively and if it is less than 2.0mmol/l, calcium supplements are required. The patient may recover, if not the patient should be treated throughout his lifetime. Although rare, due to improved pre-conditioning of patients prior to surgery for thyrotoxic conditions, acute thyrotoxic crises are possible. It may occur due to handling of the gland. Features include sweating, fever, tachycardia and hypertension. Lastly, the scar can become hypertrophic or keloid, especially when the incision has been placed low in the neck. 20/01/09
2
