Venolaryngeal Obstruction Syndrome (VLOS): Characterizing Airway Obstruction in Massive Thyroid Goiters

Objectives: Characterize the presentation of chronic airway obstruction for patients presenting with massive thyroid goiters. Methods: Demographic data acquisition was undertaken on 5 patients who presented with a compressive goiter and had pre-operative severe airway obstruction secondary to supraglottic and laryngeal edema. Each patient had a resolution of severe airway obstruction post-thyroidectomy. Results: In all, 5 patients were diagnosed with severe airway obstruction due to chronic obstruction by a thyroid goiter. Several airway management interventions were pursued during definitive surgery (conventional or videolaryngoscopic intubation and a hybrid endoscopic approach incorporating the Seldinger technique). Successful thyroidectomy led to rapid resolution of laryngeal edema. Conclusion: Venolaryngeal obstruction syndrome is proposed as a term to describe the laryngeal findings in compressive goiters. The pathophysiological sequence resulting in chronic airway obstruction may have similar mechanisms to expanding neck hematomas after thyroid surgery.