Tracheal Laceration and Endotracheal Tube Cuff Rupture During Thyroidectomy: A Case Report and Literature Review

The combination of tracheal injury during thyroidectomy and simultaneous endotracheal tube cuff rupture can complicate ventilation and airway management during anesthesia and surgery.We report a case of a 59year-old woman undergoing elective right hemithyroidectomy with a 7.0-mm electromyographic endotracheal tube (NIM EMG Endotracheal Tube; Jacksonville, FL: Medtronic Xomed Inc.) for recurrent laryngeal nerve monitoring.Approximately 100 min after induction of anesthesia, during dissection near Berry's ligament with a LigaSure bipolar vessel-sealing device (Boulder, CO: Covidien), an anterior tracheal laceration was recognized.Expiratory tidal volume decreased from 500 mL to approximately 350 mL, accompanied by an audible air leak in the operative field.The defect was repaired primarily, and a saline leak test confirmed closure.However, a persistent oral air leak, a completely flaccid pilot balloon, and immediate loss of pressure after reinflation indicated concomitant cuff rupture.Because the trachea had just been repaired and the operation was nearing completion, the existing tube was retained.Tidal volume was reduced to 400 mL, respiratory rate was increased from 10 to 12 breaths/min, and the cuff was repeatedly reinflated under continuous manometric monitoring to obtain a transient partial seal.With these measures, expiratory tidal volume remained close to 400 mL, end-tidal carbon dioxide (EtCO 2 ) remained at 36-38 mmHg, and peripheral oxygen saturation (SpO 2 ) remained at 99-100%.Surgery was completed without tube exchange, and the patient was extubated awake.Mild cervical subcutaneous emphysema resolved within 48 h.At six-month follow-up, she remained clinically well, with normal vocal cord mobility and no clinical sequelae attributable to the tracheal injury.