Posterior Tracheal Wall Injury during Mini-tracheostomy in a Post-total Thyroidectomy Patient: A Case Report

Mini-tracheostomy is a valuable technique for airway management and secretion clearance; however, it carries a risk of complications, particularly in patients with altered tracheal anatomy. We report a case of a 77-year-old woman with a history of total thyroidectomy who underwent mini-tracheostomy under bronchoscopic guidance. Because of significant tracheal mobility and a softened tracheal wall, the procedure resulted in a posterior tracheal wall injury that led to substantial mediastinal emphysema. Despite this complication, the patient's condition remained stable, and conservative management was effective. By day 5, the tracheal injury had sealed with granulation tissue, and she was discharged on day 21. No long-term sequelae were observed during 24 months of follow-up, and there was no evidence of tracheal stenosis. This case underscores the risks of mini-tracheostomy in patients with increased tracheal mobility, possibly related to post-thyroidectomy status, and highlights the importance of precise procedural techniques. Continuous bronchoscopic monitoring and detailed anatomical evaluation that considers past medical history are essential for early complication detection and optimal patient outcomes.