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Does neck extension elevate the thyroid gland cephalad to potentially improve access during thyroidectomy?
Jonathan W Serpell1, Simon F A Grodski, Christopher O'Donell
1Breast, Endocrine and Surgical Oncology Unit, Frankston Hospital and Department of Surgery, Monash University, Melbourne, Victoria, Australia. jwserpell@ozemail.com.au
ANZ Journal of Surgery
|November 18, 2003
Summary
Neck extension during thyroidectomy imaging shows minimal thyroid movement (5 mm), which is statistically significant but likely not clinically useful. Overextension should be avoided due to associated risks.
Area of Science:
- Radiology
- Surgical Anatomy
- Thyroid Imaging
Background:
- Thyroidectomy requires neck extension for optimal surgical exposure.
- Preoperative computed tomography (CT) scans of large goiters are typically performed in a neutral neck position.
- The discrepancy between scanning and surgical positions may affect thyroid gland assessment.
Purpose of the Study:
- To quantify thyroid gland movement during neck extension using CT.
- To evaluate the clinical relevance of thyroid movement in the surgical position.
Main Methods:
- CT scans of the neck were performed on 14 patients in both neutral and extended positions.
- The inferior thyroid gland's position relative to the sternal notch was measured.
- Correlation between neck extension degree and thyroid movement was analyzed.
Main Results:
- A median thyroid gland movement of 5 mm was observed with neck extension (P = 0.0002).
- This cephalad movement was statistically significant.
Conclusions:
- The observed thyroid movement with neck extension is minimal and of questionable clinical significance.
- Avoiding excessive neck extension during CT is recommended due to risks like pain and potential spinal injury.