Anatomical approach to surgery for intrathoracic goiter

Vaiman, Michael; Bekerman, Inessa

doi:10.1007/s00405-016-4322-9

Cited by 6 publications

(12 citation statements)

References 19 publications

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“…The angle of dissection is awkward and makes visualisation of the anatomy difficult. In these cases the recurrent laryngeal nerve (RLN) is likely to be in a more anterior position and therefore more vulnerable to injury [26]. If these goitres also reach the posterior pleura the risk of iatrogenic uncontrolled pneumothorax is real [17].…”

Section: Itg Extending To the Posterior Mediastinum: Retrotracheal Anmentioning

confidence: 99%

Surgical management of intrathoracic goitres

Simó

Nixon

Poorten

et al. 2018

Eur Arch Otorhinolaryngol

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Background Intrathoracic goitres (ITG) often present with compressive symptoms and require specialised care by experienced surgical teams. Most ITG can be accessed by a transcervical approach (TCA) and only between 1 and 15% will require an extracervical approach (ECA). Many controversies exist regarding the clinical presentation, evaluation, selection of cases for ECA, surgical technique and outcomes. This paper reviews the recent literature on the management, outcomes and evidence-based treatment strategies of ITG. Methods We conducted a review of the literature on the evaluation, management and outcomes of surgery for ITGs. Results The incidence of cancer in the ITGs ranges between 4 and 20%. Multiplanar CT scanning offers the best preoperative evaluation and aids to determine the approach. Most ITG can be accessed by TCA and ECA are only needed in maximum 15% of cases. In experienced hands, the outcome of these surgeries is comparable to thyroid surgery for non-ITG. Conclusions Surgery for ITG is challenging. The experienced surgeon however, with few exceptions can address ITG via TCA, with outcomes comparable to those of uncomplicated thyroid surgery.

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Section: Itg Extending To the Posterior Mediastinum: Retrotracheal Anmentioning

confidence: 99%

Surgical management of intrathoracic goitres

Simó

Nixon

Poorten

et al. 2018

Eur Arch Otorhinolaryngol

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“…The 3D reconstruction of the CT images is needed for this purpose because the inlet is oblique and cannot be assessed properly at the initial CT images. It was recently demonstrated that “the area of the thoracic inlet, the neck size, and the anteroposterior diameter of the inlet do not affect the development of the ITG” . This research indicates that “the smaller tracheal‐diameter‐to‐thoracic‐inlet ratio and the lower position of the thyroid gland are the main indicators for the development of the ITG” and that anatomical considerations are to be taken into account when the surgery for ITG is planned.…”

Section: Discussionmentioning

confidence: 94%

“…It was recently demonstrated that "the area of the thoracic inlet, the neck size, and the anteroposterior diameter of the inlet do not affect the development of the ITG". 21 This research indicates that "the smaller trachealdiameter-to-thoracic-inlet ratio and the lower position of the thyroid gland are the main indicators for the development of the ITG" and that anatomical considerations are to be taken into account when the surgery for ITG is planned. We confirm the importance of such approach and indeed in the only case when the posterior thoracotomy was performed the anatomical peculiarities of the given patient influenced the surgical decision making.…”

Section: Discussionmentioning

confidence: 97%

Surgical approach to the intrathoracic goiter

Vaiman

Bekerman

Jabarin

et al. 2018

Laryngoscope Investig Oto

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ObjectiveIn a retrospective study, the authors analyzed the surgical approach to the intrathoracic goiter to avoid sternotomy or thoracotomy.MethodsWe selected 70 intrathoracic cases of multinodular goiter out of 988 cases of thyroidectomy and compared them with cervical goiter cases. Surgical technique, results, and postsurgical complications were assessed.ResultsThe analyzed cases presented the retrosternal goiter (n = 53; 75.7%), the retrotracheal goiter (n = 9; 12.8%), and the retroesophageal goiter (n = 8; 11.4%). Complaining of chest pressure or discomfort was specific for intrathoracic cases (50%; 35 of 70). All goiters except one were removed via cervical incision. The surgeons used head reclination and isthmus dissection when removing sizable goiters. Mean weight of goiters was 180 g. The recurrent laryngeal nerve was more often temporarily damaged in intrathoracic cases in comparison with cervical cases (4.3% vs. 2.8%, P = .04), but the difference in permanent injury was less significant (P = .09). The incidence of temporary hypoparathyroidism was significantly higher in intrathoracic cases (P = .01).ConclusionIn cases of multinodular goiter the goiters of various extensions can be successfully removed via the cervical incision in most of the cases even if they occupy the retrosternal, retrotracheal, or retroesophageal position. The transthoracic approaches and sternotomy might be justified in malignant cases.Level of Evidence4.

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“…Approximately 85-90% of the enlarged thyroid glands appear as a mass which can press in the cervical region and approximately 10-15% of them appear as a mass which can press in the retrosternal region 3. Together with the incomprehensibility about goiter still, the incidence of RSG differs between studies.…”

Section: Discussionmentioning

confidence: 97%

“…Increased level of thyroid stimulating hormone (TSH), iodine deficiency in the diet and clinical reflection of many pathologies may cause this 1. Though 85-90% of the goiters are in the cervical region and 10-15% in the intrathoracic region, although they differ between the studies 3. The concept of substernal goiter was first used by Haller and since then this concept has been controversial and it still does not have a single definition today 4,5.…”

Section: Introductionmentioning

confidence: 99%

Retrosternal Goiter: A couple of classification methods with computed tomograpy findings

2018

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Objectives:The retrosternal goiter (RSG), which can be defined by different classification and its incidence between 2% and 26% of all thyroidectomized patients, is a thyroid gland disease. Our aim was to classify RSG cases with a couple of different ways, which we have detected in computed tomography (CT) imaging of the thorax.Methods:In this retrospective study conducted at Kars Harakani State Hospital Pulmonary Medicine Polyclinic between June 2014 and June 2017 in which 176 patients were included. The age, sex, diagnostic codes, retrosternal extension of the thyroid gland (aortic upper arch, aortic reaching arch and aortic inferior arch), extension type (prevascular, paratracheal retrovascular and retrotracheal), extension amount (mm) (<50% and 50%<) of thyroid gland of the patients were assessed.Results:About 56.25% (n=99) were female and the mean age was 65.9±11.4 years. The most common co-morbid disease in patients with RSG was Chronic Obstructive Pulmonary Disease (COPD) (52.3%). Thirty nine (22.2%) of the patients had associated nodule, 16 (9.1%) had accompanying tracheal pressure and one patient had nodule and tracheal pressure. 27.3% of the patients’ gland’s right lobe and 28.9% of the patients’ left lobe were extended >50% below the thoracic entry. Left thyroid gland’s (90.3%) retrosternal extension and aortic arch spread (91.2%) were more. When classified according to the trachea, the left lobe’s paratracheal and retrovascular extension (50.9%) was more. Extension amounts were similar for both thyroid lobes.Conclusion:In patients who have retrosternal goiter, goiter spread can be defined with multiple classification with thorax CT.

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Anatomical approach to surgery for intrathoracic goiter

Cited by 6 publications

References 19 publications

Surgical management of intrathoracic goitres

Surgical management of intrathoracic goitres

Surgical approach to the intrathoracic goiter

Retrosternal Goiter: A couple of classification methods with computed tomograpy findings

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