“… elective total thyroidectomy and left neck dissection. Post-op period complicated by stridor on extubation. Reintubated and returned to theatre for left vocal cordotomy, ligation of leaking chyle duct, repair of left common carotid bleeding. On extubation in theatre again developed stridor so underwent tracheostomy. Developed pneumothorax with subsequent extensive surgical emphysema to chest wall, neck and face.”

Head and neck surgery is by its nature often high risk. All of those involved should be familiar with and ready to deal with airway obstruction and airway or neck bleeding. Likely complications should be anticipated, actively checked for and managed promptly. When problems occur, there should be joint assessment by anaesthetist and surgeon and, when necessary, early re-intubation to protect the airway. In this case, the patient and team unfortunately seem to have encountered the full gamut of complications possible.