A critical analysis of 33 patients with substernal goiter surgically treated by neck incision

Abstract

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.

Figure 1

Chest X-ray showing deviated trachea and enlarged upper mediastinum due to substernal goiter.

Figure 2

CT scan showing goiter displacing mediastinal structures.

Figure 3

Desenho do bócio com marcação da incisão cirúrgica.

Figure 4

Releasing the sternocleidomastoid muscle during surgery.

Figure 5

Sectioning prethyroid musculature.

Figure 6

two-finger palpation with dislocation of the substernal goiter lobe.