Tracheal Configuration as a Radiographic Predictor of Difficult Tracheal Intubation in Goiters

Background: Goiters producing tracheal deviation or tracheal narrowing (TN) or both may cause difficult tracheal intubation (DTI). This study is to determine whether pre-operative assessment of trachea on neck radiograph can serve to predict DTI in goiters Methods: Pre- thyroidectomy radiographs of 160 patients were retrospectively studied for tracheal narrowing and deviation. Patients’ clinical and surgical data including Anaesthesiologists’ documented intubation experiences were also evaluated. Tracheal narrowing and relative sizes of the goiter were assessed on frontal and lateral neck radiographs. . Goodman Kruskal Tau cross tabulation analysis with SPSS 11.0 for windows was used to correlate TN to Anaesthetists operative reports of ease or difficulty of intubation. Results: Coronal and sagittal tracheal diameters ranged between 3mm to 27mm. It was less than 7mm in one or both planes in 21 (13.2%) of patients and all had DTI, P = 0.019. The length of TN did not show significant statistical correlation to DTI, P = 0.791. The only two patients having coronal or sagittal tracheal diameter less than 5mm, had failed intubation and surgery was done using bilateral superficial cervical plexus block. Conclusions: Goiters producing luminal TN of less than 7mm have potential for DTI and failed intubation when less than 5mm. Key words: Goiter, Difficult intubation, plain radiograph, thyroidectomy, Trachea