What question did this study set out to answer?

This research focuses on the challenges of distinguishing the trachea from the esophagus during intubation caused by thyroid-driven airway distortion.

May 15, 2026Cureus0 citationsOpen Access

Featureless Trachea Mimicking the Esophagus During Awake Fiberoptic Intubation Secondary to Longstanding Thyroid Compression

KNKeerthi NadarajSri Ramachandra Institute of Higher Education and Research MMMekha Elizabeth Mathew VSVenkatesh SelvarajSri Ramachandra Institute of Higher Education and Research

Key Points

This research focuses on the challenges of distinguishing the trachea from the esophagus during intubation caused by thyroid-driven airway distortion.
Evaluated patients with giant thyroid masses causing tracheal compression during awake fiberoptic intubation.
Employed meticulous endoscopic assessment to confirm tracheal entry and avoid misplacement.
Identified severe tracheomalacia in patients, leading to a featureless trachea during intubation.
Observed increased risk of misplacement during fiberoptic intubation in the presence of tracheal distortion.

Abstract

Giant thyroid masses causing prolonged tracheal compression may lead to severe tracheomalacia, where progressive erosion of cartilaginous rings renders the trachea smooth, featureless, and difficult to distinguish from the esophagus during bronchoscopy. This poses a significant risk during awake fiberoptic intubation. Such airway distortion requires heightened vigilance, meticulous endoscopic assessment, and confirmation of tracheal entry to prevent misplacement. Early recognition and a systematic airway strategy are crucial for optimal patient safety and outcomes.

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