The surgical approach to retrosternal goiters: The role of computerized tomography

Grainger, Joe; Saravanappa, Natarajan; D’Souza, Alwyn; Wilcock, D.J.; Wilson, Paul

doi:10.1016/j.otohns.2005.01.039

Cited by 60 publications

(60 citation statements)

References 7 publications

(21 reference statements)

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“…Conversely, the lack of radiologic extension beyond the aortic arch predicted successful transcervical removal of mediastinal goiters without sternotomy. The same finding was previously observed by Grainger et al 15 based on CT scan evaluation. However, their results were based on just 3 patients requiring sternotomy out of a rather small cohort (24 patients).…”

Section: Discussionsupporting

confidence: 90%

Preoperative predictors of sternotomy need in mediastinal goiter management

et al. 2010

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Background. The objective of this study was to identify the preoperative risk factors for patients in need of a sternotomy in the management of mediastinal goiters in order to provide better preoperative planning and patient consent.Methods. We analyzed 98 patients who underwent surgery for mediastinal goiters (goiters extending below the thoracic inlet 3 cm with the neck in hyperextension) between 1995 and 2008. Twelve (12.2%) of the patients required a sternotomy. The patients' features were analyzed by the surgical approach performed. Logistic regression analysis was used to study which variables were influencing the surgical strategy. The receiver operating characteristic (ROC) curves were designed when appropriate.Results. Terms such as retrosternal, substernal, intrathoracic, or mediastinal have been used to describe a goiter that extends beyond the thoracic inlet. Although suppression therapy by exogenous thyroxine can reduce the size of the gland by 20% to 30%, 1 the consensus is that the mediastinal goiter is a condition that requires surgical management. Literature reports often stress the need for surgical treatment in relation to compressive symptoms, potential airway compromise, and the possibility of an association with thyroid malignancy. 2-6The mediastinal thyroid can be usually managed through a cervical incision. 7 This approach has been shown to be sufficient in up to 97% of cases. 5 In patients in whom the gland cannot be safely removed through a cervical incision, thyroidectomy may require a thoracic approach to gain adequate exposure and to remove the gland while avoiding dangerous tractions. Unfortunately, there is no clear demarcation of the cases that require a combined approach, and the Correspondence to: G. Pata

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Section: Discussionsupporting

confidence: 90%

Preoperative predictors of sternotomy need in mediastinal goiter management

et al. 2010

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“…An upper GI series with esophageal contrast (A-P and lateral views) allows for determining the degree and site of the goiter compressing the trachea and esophagus. The most reliable data describing the goiter size and its position in relation to the adjacent structures are provided by computed tomography (CT) or magnetic resonance imaging (MRI) [17,18].…”

Section: Introductionmentioning

confidence: 99%

Surgical management of mediastinal goiter: risk factors for sternotomy

Cichoń

Anielski

Konturek

et al. 2008

Langenbecks Arch Surg

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Surgical management of patients with mediastinal goiter is the therapeutic modality that requires considerable experience of the surgical team, performed in specialized centers, and appropriate preoperative diagnostic management. Statistically significant risk factors for sternotomy are as follows: recurrent goiter, primary mediastinal goiter, posterior mediastinal location of goiter, and the presence of an aberrant adenoma situated in the mediastinum.

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“…Prevalence rates of substernal goiter range between 1% and 21% of goiter cases [3][4][5][6][7][8][17][18][19] ; in spite of being a relatively frequent finding, clinical diagnosis is not always obvious.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with enlarged glands can be asymptomatic in 10% to 35% of the cases 3,4,6,7,9,10,17,19,20 while some authors claim such rate to be as high as 50% 8,9 .…”

Section: Discussionmentioning

confidence: 99%

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Avaliação crítica de 33 pacientes com bócio mergulhante tratados cirurgicamente por cervicotomia

Neves

Rosano

Hojaij

et al. 2009

Rev. Bras. Otorrinolaringol.

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The possibility of needing a combined access, with neck and chest incisions makes the treatment of substernal goiter a challenge both in the pre-op and the intraoperative. We hereby, discuss a standardization of the surgical technique to minimize the need for a chest approach, making the substernal goiter a surgically treatable disease, through a single neck incision, and with low indices of complication. Aim: to assess the substernal goiter surgically approach through a neck incision and to analyze the surgical complications. Materials and methods: we carried out a historical cohort by retrospective analysis of the charts of patients submitted to thyroidectomy, and 33 of them (10.4%) had substernal goiter. Results: all 33 patients were surgically treated through a neck incision without the need for sternotomy. We did not observe definitive lesions in the inferior laryngeal nerve or definitive hypoparathyroidism. Only 2 patients had recurrent nerve paresis; and 2 patients were re-operated because of a neck hematoma. Conclusion: patients with substernal goiter can be safely treated surgically through a single neck incision, bearing low complication rates.

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The surgical approach to retrosternal goiters: The role of computerized tomography

Abstract: In such cases in which sternotomy is anticipated, the availability of cardiothoracic services would be helpful to avoid patient morbidity.

Cited by 60 publications

References 7 publications

Preoperative predictors of sternotomy need in mediastinal goiter management

Preoperative predictors of sternotomy need in mediastinal goiter management

Surgical management of mediastinal goiter: risk factors for sternotomy

Avaliação crítica de 33 pacientes com bócio mergulhante tratados cirurgicamente por cervicotomia

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