Difficult tracheotomy in a patient with massive anaplastic thyroid cancer

Tracheotomy is a surgical procedure involving an incision of the soft tissues of the neck and the anterior wall of the trachea in an appropriate place in order to obtain direct access to its lumen and insert a tracheostomy tube. Although it is a frequently used procedure and its performance is a basic skill of an otolaryngologist, in some cases it can be a real challenge. This paper presents the case of a 74-year-old patient transferred to the Department of Otolaryngology and Laryngological Oncology of the University Clinical Hospital in Poznan due to increasing dyspnea at rest for 2 days resulting from the presence of a huge tumor in the neck – a recurrence of anaplastic thyroid cancer. In the patient, after analyzing computed tomography images, performing a neck ultrasound and determining the exact position of the trachea, a tracheotomy was performed with an atypical approach. A vertical incision in the neck was made on the left side, lateral to the thyroid tumor, and after dissection of the soft tissues, the trachea compressed by the tumor, deformed and significantly shifted to the left, was exposed. The trachea was incised and a tracheostomy tube was inserted.