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. 2013 Aug 1;6(7):488-96.
Print 2013.

Surgical treatment of large substernal thyroid goiter: analysis of 12 patients

Bo Gao  1 , Yan Jiang, Xiaohua Zhang, Jianjie Zhao, Yujun He, Yayuan Wen, Shu Zhang, Donglin Luo
Affiliations

Surgical treatment of large substernal thyroid goiter: analysis of 12 patients

Bo Gao et al. Int J Clin Exp Med. .

Abstract

This study was carried out to evaluate the clinical presentation, surgical treatment, complications, and risk of malignancy for large substernal goiter. From March 2010 to December 2012, 12 patients with large substernal thyroid goiter who underwent surgery in our Department were enrolled in the study. Their medical records were retrospectively analyzed. Collar-shaped incision was adequate for resection of the lesions in 10 (83%) patients, while two (17%) patients required combined cervical-thoracic incision. In addition, one case was subjected to postoperative tracheotomy. Transient hypocalcaemia occurred in one case. The incidence of transient hoarseness, tracheomalacia and hypothyroidism was 8.3%. There was no perioperative bleeding, thyroid storm as well as other serious complications. All patients were clinically cured. Therefore, cervical collar incision is nearly always adequate for most cases of larger substernal goiter, and sternotomy can be avoided. Furthermore, the application of intraoperative ultrasonic knife can effectively reduce intraoperative and postoperative complications. Aggressive perioperative management is crucial for the successful removal of large substernal goiter.

Keywords: Substernal goiter; complications; operative approach; ultrasonic knife.

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Figures

Figure 1
Figure 1
Pictures showing anterior neck masses.
Figure 2
Figure 2
Anteroposterior chest X-ray and barium meal test: Chest X-ray revealed widened superior mediastinum tracheal shift to the uninjured side of the chest due to compression. Upper gastrointestinal series unveiled esophageal deviation to unaffected side of the chest due to compression.
Figure 3
Figure 3
CT scans showing significantly enlarged thyroid, which extends from the lower part of jaw to the level of the aortic arch through the thoracic inlet. Tracheal deviation toward unaffected side of the chest due to compression.
Figure 4
Figure 4
Pictures showing cervical surgical approach and the dissected tissues.
Figure 5
Figure 5
Postoperative negative pressure drainage.
Figure 6
Figure 6
Combined cervical-thoracic approach.
Figure 7
Figure 7
The left picture showing tracheomalacia following the tumor removal. The right picture demonstrating ventilator-assisted breathing after tracheotomy.
See this image and copyright information in PMC

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