Thyroid surgery and anaesthesia following head and neck irradiation for childhood malignancy

Background: Increasing numbers of adolescents and young adults are undergoi ng thyroid surgery because of the risk of malignancy following previous irr adiation for childhood malignancy. irradiation to the head and/or neck regi ons may induce changes in the soft tissues and larynx that are far from nor mal with respect to both size and mobility. The aim of the present study wa s to evaluate the possible impact of such changes on both surgical and anae sthetic technique during thyroidectomy. Methods: This was a retrospective case study. Thirty consecutive patients u ndergoing total thyroidectomy following previous irradiation for childhood malignancy formed the study group. Results: There were no permanent surgical or anaesthetic complications in t he group. In particular there were no cases of either permanent recurrent l aryngeal nerve palsy or permanent hypoparathyroidism. Twenty-eight patients had an uneventful intubation and two were unable to be intubated directly, one requiring fibre-optic bronchoscopic intubation and the other having su rgery performed with a laryngeal mask following failed bronchoscopy. Both o f these patients had received high-dose direct irradiation to the larynx fo r solid rumours. Conclusions: Despite potential difficulties associated with the heavily irr adiated larynx, thyroid surgery and anaesthesia can be performed safely wit h minimal complications in experienced hands.