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Surgery Essay

Discuss the possible compilations


of thyroid surgery.
There are three types of complications in thyroid surgery:
complications in the operating theatre itself, problems
with analgesia, and problems specific to the
thyroidectomy itself.

The dangers to the patient in the operating theatre


include: bruising and burns with diathermy and alcohol. There
might also be complications due to anaesthesia. The
positioning of the patient during thyroid surgery is with a fully
extended neck. This can cause problems during intubation and
extubation such as tracheal collapse.

Post thyroid surgery, haemorrhage may occur, which can


compress structures in the thoracic inlet, leading to venous
engorgement, tracheal compression and asphyxia. The wound
must be reopened urgently and the patient intubated and taken
back to theatre for exploration of wound, removal of
haematoma and control of bleeding.

The external branch of the superior laryngeal nerve may


be damaged during ligation of the vascular pedicle at the
superior lobe. Inability to tense the vocal cord results in a weak,
hoarse voice. The mucous membrane of the upper larynx,
which is supplied by this nerve is anesthetised and it makes
entry of foreign bodies easier. Damage to the recurrent
laryngeal nerve is more serious. Bruising of this nerve causes
temporary paralysis in the vocal cord, but recovery within 3

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Surgery Essay

months is usual. Division of the nerve causes paralysis of the


vocal cords midway between closed and open. The normal cord
on the other side usually compensates by crossing over in
phonation. Some degree of stridor may be evident on exertion.
Bilateral nerve injury causes stridor and ineffective coughing
when the endotracheal tube is withdrawn after the operation. In
this case the tube is reinserted and if there is no improvement
tracheostomy may be required.

Bruising or removal of the parathyroid glands leads to


hypocalcaemia and symptoms of increase neuromuscular
excitability. Chvostek’s sign is positive, when the facial nerve
is tapped over the parotid gland. Calcium levels are always
checked post-operatively and if it is less than 2.0mmol/l,
calcium supplements are required. The patient may recover, if
not the patient should be treated throughout his lifetime.

Although rare, due to improved pre-conditioning of patients


prior to surgery for thyrotoxic conditions, acute thyrotoxic
crises are possible. It may occur due to handling of the gland.
Features include sweating, fever, tachycardia and
hypertension. Lastly, the scar can become hypertrophic or
keloid, especially when the incision has been placed low in the
neck.

20/01/09