Management and Prevention of Laryngotracheal and Oesophageal Injuries in Thyroid Surgery

The management and prevention of complications to the larynx, trachea and oesophagus in thyroid surgery can be readily accomplished through the recognition of the signs and symptoms that indicate the presence of invasive disease. When these are present, the surgeon is advised to obtain more detailed cross-sectional imaging that will identify the potential sites of involvement. This will help to prepare the patient and the surgeon for the extent of surgery that will be required. The patient who is deemed to be at highest risk of having invasive thyroid cancer has the following characteristics: 1. signs and/or symptoms of invasive disease such as stridor, hoarseness, haemoptysis, a mass in the larynx or trachea, vocal cord paralysis; 2. older patients; 3. patients with recurrent central compartment cancer; 4. patients with documented metastatic cancer outside the neck. The most challenging patients, however, are the ones who are found to have invasive disease only at the time of surgery and lack any of these warning signs. It is the surgeon's responsibility to be prepared to manage invasive disease and to avoid complications through the use of techniques outlined in this chapter.