Transoral laryngeal microsurgery for supraglottic airway obstruction in thyroid goiter

Abstract

Objectives: (1) Review essential elements of the pre-operative evaluation prior to thyroid surgery with an illustrative case highlighting the importance of in-office laryngoscopy. (2) Describe the first known use of transoral laryngeal microsurgery (TLM) concurrently with thyroidectomy to address supraglottic airway obstruction due to thyroid goiter. Methods: Case report and literature review. Case presentation: A 73-year-old patient presented with symptomatic large thyroid goiter. Pre-operative evaluation of the airway, thyroid bed, neck, and neurologic function was undertaken to guide effective and safe surgical intervention. Flexible laryngoscopy, sleep polysomnogram study, and dynamic chest computed tomography led to identification of severe laryngeal mucosal changes and upper airway obstruction. The patient was successfully managed with staged thyroidectomy and concurrent TLM resection of redundant arytenoid mucosa – the first known report of this technique applied in this setting. Near complete resolution of her symptoms was achieved with no complications or long-term side effects. Conclusions: We recommend that patients with symptomatic cervical thyroid goiter undergo flexible laryngoscopy to evaluate for upper airway obstruction and propose that concurrent TLM can be considered to address laryngeal mucosal changes resulting from thyroid goiter. Keywords: Thyroid goiter, Obstructive sleep apnea, Laryngology, Endocrine surgery