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Combined Transcervical and Median Sternotomy Approach for a Massive Substernal Goiter.
Alexander E Graf1, Alexandrea J Beemer2, Rahul D Gulati1
1Department of Otolaryngology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203 USA.
Summary
A rare, massive substernal goiter (630g) causing tracheal stenosis was surgically managed. A combined approach and careful airway management, potentially avoiding tracheostomy, are recommended for similar complex cases.
Area of Science:
- Cardiothoracic Surgery
- Otolaryngology
- Endocrinology
Background:
- Massive substernal goiters are uncommon and can lead to severe airway compromise.
- Tracheal stenosis secondary to substernal goiter presents significant surgical challenges.
Purpose of the Study:
- To describe a combined surgical approach for a rare, massive substernal goiter.
- To highlight optimal airway management strategies for patients with substernal goiter and tracheal stenosis.
Main Methods:
- A combined transcervical and median sternotomy surgical technique was employed.
- A multidisciplinary team managed the patient's airway.
- Consideration was given to awake fiberoptic intubation to potentially avoid tracheostomy.
Main Results:
- Successful surgical resection of a 630g substernal goiter was achieved.
- The combined surgical approach facilitated management of the massive goiter and associated tracheal stenosis.
- Airway management strategies were critical for patient outcomes.
Conclusions:
- A combined transcervical and median sternotomy approach is feasible for massive substernal goiters.
- Multidisciplinary airway management and consideration of awake intubation are crucial for similar cases.
- Avoiding tracheostomy may be possible with careful planning and execution.
