Surgical approach to the substernal goiter

Hanson, Martin; Shaha, Ashok R.; Wu, James X.

doi:10.1016/j.beem.2019.101312

Cited by 31 publications

(68 citation statements)

References 35 publications

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“…The majority of the cases, over 90%, Martin et al [ 1 ]; 93.5%, Testini et al [ 14 ], can be treated through a Kocher's transverse collar incision while the remaining minority has been reported as might be required a partial or complete median sternotomy or even the thoracotomy. To this end, the former is usually recommended as the inferior border of the gland end up with the innominate vein, most proximally, and the latter as harboring the conditions, such as extending beyond the brachiocephalic vein towards the arcus aorta, the involvement of the posterior mediastinum, superior vena cava obstruction, recurrency, malignancy with local involvement, and emergent airway obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Since first being described by Haller in 1749, substernal goiter is simply defined as an enlargement of the thyroid gland with a component extending to the mediastinum. The surgical approach should be planned meticulously, particularly in order for proximity to the intrathoracic vital structures in topographic anatomy [ 1 ]. Substernal goiter is usually involved within the anterior mediastinum while accounting for 10%-15% within the posterior one.…”

Section: Introductionmentioning

confidence: 99%

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Sutureless Total Thyroidectomy for Substernal Goiter: Amending Versus Unnecessary

Aydin

Şengül

2021

Cureus

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Substernal goiter is an enlarged thyroid gland, harboring a component extending into the mediastinum. Surgical management requires genuine and rigorous preoperative planning as physicians could encounter the prospect of the gland coming into close quarters with the vital intrathoracic structures. The neck and chest multiplanar cross-sectional imaging provide essentialness of an extracervical approach for the procedure. In the present study, a 57-year-old female who admitted with the intermittent dyspnea and dysphagia with a huge goiter is reported. The labs were reported within the normal limits and the video laryngoscopy displayed no pathologic finding. Her neck sonography revealed the multiple nodules within the gland, without determining the most proximal border of the left lobe. The neck and chest computed tomography depicted a substernal goiter harboring the left lobe, extending till the left innominate vein and a sutureless total thyroidectomy by the collar incision without a median sternotomy was performed. We would recommend sutureless thyroidectomy for substernal goiter just considering to divide meticulously the superior thyroid arteries and veins separately and exploring the fibrous Ligament of Berry, that is, the true Ligament of Berry, with its safe relationship to the recurrent laryngeal nerve in Thyroidology.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sutureless Total Thyroidectomy for Substernal Goiter: Amending Versus Unnecessary

Aydin

Şengül

2021

Cureus

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“…The one we based our study on, is the extension of the thyroid gland below the thoracic inlet. Other definitions include goiters of which at least 50% of their volume is in the chest, goiters reaching the aortic arch, goiters with extension below the fourth thoracic vertebra or a portion of the thyroid gland that remains retrosternal at the clinical examination [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…The resultant dysphonia manifest from such an insidious process may not be overtly obvious to the patient nor the clinician. Therefore, particular care must be employed in the thorough examination of laryngeal function prior to undertaking surgery for CMG [ 6 ] .…”

Section: Discussionmentioning

confidence: 99%

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Cervical approach to cervico-mediastinal goiters: Experience of a Moroccan ENT tertiary center - Case series

Oukessou

Mennouni

Douimi

et al. 2021

Annals of Medicine and Surgery

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Background The purpose of the study was to analyze and discuss the demographic, clinical, radiological, therapeutic and postoperative findings of the Cervico-mediastinal goiters (CMG) treated through a cervical approach admitted in the ENT department of Ibn Rochd university hospital, Casablanca, Morocco between January 2014 and January 2020. Materiels and methods Over a period of 6 years, 116 patients underwent surgical treatment for CMG. It was defined as a goiter extending below the plane of superior thoracic aperture on CT scan. All our patients had clinical, biological and radiological assessment before surgery. A nasofibroscopy was carried out pre and postoperatively. All the CMG have been extracted trough a cervical approach by an experimented ENT surgeon. Results 84,48% of the CMG was diving into the anterior mediastinum and 15.52% into the posterior. The CMGs extended above, at, and below the level of the aortic arch respectively in 76.72%, 18.10% and 5.17% of the patients. All of 116 goiters were successfully removed through a cervical approach. No patient required a sternotomy. Postoperatively, vocal cord paralysis was transient in 3 patients (2.58%) and permanent in 2 patients (1.72%). Hypocalcemia was transient in 10 patients (8.62%) and permanent in 2 patients (1.72%). Final histology found 106 benign multinodular goiters (91.37%), 7 papillary carcinomas (6.03%) and 3 vesicular carcinomas (2.58%). No death was noted. Conclusions With expertise in thyroid surgery, cervical approach for CMGs is safe and sufficient in the majority of the cases with low morbidity rate and no mortality.

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Hyperthyroidism secondary to a primary mediastinal goiter with normal functional cervical thyroid gland

Kardi

Oueslati

Yazidi

et al. 2021

Clinical Case Reports

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Surgical approach to the substernal goiter

Cited by 31 publications

References 35 publications

Sutureless Total Thyroidectomy for Substernal Goiter: Amending Versus Unnecessary

Sutureless Total Thyroidectomy for Substernal Goiter: Amending Versus Unnecessary

Cervical approach to cervico-mediastinal goiters: Experience of a Moroccan ENT tertiary center - Case series

Hyperthyroidism secondary to a primary mediastinal goiter with normal functional cervical thyroid gland

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