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Retrosternal Thyroid with Mediastinal Extension: Surgical Approach and Management.

Sharmistha Chakravarty1, Nitin M Nagarkar1, Amritava Ghosh2

  • 1Department of ENT & Head Neck Surgery, All India Institute of Medical Sciences, G.E Road, Tatibandh, Raipur, C.G 492099 India.

Indian Journal of Otolaryngology and Head and Neck Surgery : Official Publication of the Association of Otolaryngologists of India
|June 5, 2023
PubMed
Summary

Sternotomy is not solely determined by the size of retrosternal goiters. Clinical symptoms like difficulty breathing and voice changes, not just radiological extent, influence the surgical approach for goiter excision.

Keywords:
MediastinumRetrosternal goitreSternotomyThoracic inletThyroidectomy

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Area of Science:

  • Otorhinolaryngology
  • Thoracic Surgery
  • Endocrinology

Background:

  • Retrosternal goiters can present with significant clinical challenges.
  • Surgical management requires careful consideration of the extent and approach.
  • Sternotomy may be necessary for complete excision but carries risks.

Purpose of the Study:

  • To evaluate clinical presentations of retrosternal goiters.
  • To determine factors influencing the need for sternotomy during surgical excision.
  • To assess the correlation between radiological extent and surgical approach.

Main Methods:

  • Retrospective review of 22 patients undergoing total thyroidectomy for retrosternal goiter.
  • CT scans used to assess mediastinal extension.
  • Patients categorized by surgical approach: trans-cervical vs. trans-cervical plus sternotomy.
  • Statistical analysis using Chi-square or Fisher exact test.

Main Results:

  • Common symptoms included dyspnea (27%), hoarseness (13%), and dysphagia (9%).
  • Retrosternal extent was grade 1 in 11 patients and grade 2 in 11 patients.
  • Radiological extent did not significantly correlate with the need for sternotomy (OR 1.45 for grade 2).
  • 13 patients (59%) had tracheal deviation on CT scan.

Conclusions:

  • The decision for sternotomy in retrosternal goiter excision depends on clinical symptoms (dysphagia, dyspnea, hoarseness) rather than solely on radiological extent.
  • Complete excision and preservation of vital structures are challenging in the thoracic inlet.
  • Sternotomy is crucial for complete excision and protection of mediastinal vessels.