Dr.Guttler’s comments:

1. To avoid this kind of complication, the procedure should be performed under local anesthesia, Isthmus nodules need special preparation.
2. In several thousand reported cases this outcome was not mentioned. It is a very rare occurrence done by inexperienced operators. More cases will occur if the operators are not trained and gain experience before doing a difficult isthmus nodule.
3. Local Lidocaine and hydrodissection with Dextrose.
4. Using General anesthesia does not allow the operator to interact with the patient to tell about symptoms until too late.
5. Only post RFA procedure did the operator know about symptoms of dysphonia and cervical pain implicating a third-degree skin burn of the medial cervical region progressing to severe soft-tissue and cervical tracheal necrosis.
6. To avoid these kinds of complications, the procedure should be performed under local anesthesia, by an expert operator with experience doing difficult cases.
7. Using cooled dextrose solution hydrodissection between trachea, thyroid and skin allows the operator to separate the trachea and skin from the heat from the electrode.
8. There was no symptoms just cosmetic issues. Ahead of radiofrequency ablation, patients should be informed of possible major complications, especially if the indication is cosmetic.
9. Call me for details of my outpatient local anesthesia procedure.
10. 310-393-8860 or secure email to thyroid.manager@thyroid.com.
11. Ask for Alicia.
12. Dr.G.

European Annals of Otorhinolaryngology, Head and Neck Diseases

Morvan et al N

Available online 16 August 2021

Case report:Tracheal necrosis following thyroid radiofrequency ablation

Abstract

Introduction

Radiofrequency ablation for benign thyroid nodules has a low rate of complications in experienced hands for selected indications, but tracheal necrosis is a major complication.

Case report

A 60 year-old female patient underwent percutaneous radiofrequency ablation of an unesthetic benign isthmic thyroid nodule. The procedure was performed with a cooled electrode, using the “moving shot” technique on a trans-isthmic approach, under general anesthesia. Postoperative course was complicated by dysphonia and cervical pain implicating a third-degree skin burn of the medial cervical region progressing to severe soft-tissue and cervical tracheal necrosis.

Discussion

Risk factors in the present case included the general anesthesia, isthmic location and thyroid nodule volume. To avoid this kind of complication, the procedure should be performed under local anesthesia, using cooled dextrose solution hydrodissection between trachea, thyroid and skin. Ahead of radiofrequency ablation, patients should be informed of possible major complications, especially if the indication is cosmetic.