engleski

Cervical approach for substernal goiter

Introduction: In substernal goiter at least 50 % of the gland lies inferior to the thoracic inlet. It usually occurs in fifth and sixth decade, with incidence three to four times greater in woman than in man. According to major vessels and recurrent laryngeal nerve, substernal goiter can be anterior and posterior. Substernal goiter is best diagnosed by radiological studies, ultrasound, cytological and radionuclide scintigraphic methods. Due anatomy and location behind sternum, ultrasound, cytological and scintigraphic methods are not always reliable. Computerized tomography (CT) or magnetic resonance imaging is useful for evaluation of goiter substernal extension and tracheal dislocation and compression. Surgical procedure is more difficult because of possible dislocation of anatomic structures, difficult identification of recurrent laryngeal nerve and parathyroid glands, intraoperative bleeding. Majority of substernal goiters can be removed through cervical incision, but occasionally sternotomy is necessary which prolongs postoperative recovery. Material and Methods: We will demonstrate our experience and results in surgical treatment 96 cases of substernal goiter. Results: In presentation of substernal goiter, majority had cervical mass (95.8 %), respiratory symptoms (91.6%), dysphagia (48.9 %), acute airway (11.4 %), and some of them were asymptomatic (12.5 %). Indication for surgery were pressure effects in longstanding goiter, potential for acute airway problems, potential for malignancy, unsuccessful medical treatment, and minimal operative morbidity and mortality. All substernal goiter were remover via cervical incision. There were no cases of operative deaths, vocal cord paralysis and in 3.1 % were detected hypocalcaemia. Conclusions: Transcervical approach for substernal goiter is partially different from that used for routine thyroid surgery and need experienced surgeon. The majority of the substernal goiters can be resected transcervicaly, but rarely will require a sternal split.

thyroid gland; goiter

nije evidentirano