Prevention of airway complications in thyroplasty patients requiring endotracheal intubation

Patients who have undergone silicone vocal card medialization and require a dditional surgery are at risk for airway complications. There is a narrowed glottic aperture: that may be prone to develop postoperative laryngeal ede ma and prosthesis extrusion. This study was designed to assess the manageme nt of this difficult airway and to determine the frequency of postintubatio n complications. We identified 82 patients who had undergone vocal cord med ialization with silicone implants between 1991 and 1995. Seventeen of these patients underwent additional surgical procedures requiring general anesth esia. A retrospective review of these patients' charts was performed to det ermine the management of the airway and the incidence of postintubation com plications. There were no postintubation complications in the 17 patients w ho were studied. The duration of surgery ranged from 40 minutes to 4 hours 15 minutes. Two patients were ventilated via bronchoscope, and 15 patients were intubated orally. The endotracheal tubes ranged from size 6 to size 9 (median size 8). None of the patients required perioperative steroids. All patients were successfully extubated in the recovery room. No patients requ ired intubation or tracheotomy, and there were no implant extrusions. In th is study, the incidence of postintubation ail way complications in patients who had undergone previous thyroplasty was minimal. Nevertheless, the pote ntial for airway compromise exists. We recommend preoperative discussion wi th the anesthesiologist, atraumatic intubation with a small endotracheal tu be? and diligent observation for airway compromise.