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3 results

  • Sternotomy for substernal goitre: an otolaryngologist's perspective

  • P Burns, J Doody, C Timon
  • Journal:
    The Journal of Laryngology & Otology / Volume 122 / Issue 5 / May 2008
    Published online by Cambridge University Press:
    11 July 2007, pp. 495-499
    Print publication:
    May 2008
  • Introduction:

    Large substernal goitres present a challenge to the otolaryngologist due to their size and location. Predicting which patients will require sternotomy can enable planning of surgery in a specialist centre, with the assistance of a thoracic surgeon. Our aim for this study was to establish clinical and radiological predictors which would aid the otolaryngologist in the pre-operative planning of such cases.

    Methods:

    A retrospective medical record review was conducted for all patients undergoing thyroidectomy for substernal goitre who required sternotomy in our institution over a 10-year period.

    Results:

    During the study period, 140 patients with substernal goitres underwent thyroidectomy. Three patients (2 per cent) required sternotomy. These cases are described.

    Conclusions:

    Radiological evidence of extension of a substernal goitre to the aortic knuckle, or loss of tissue planes on computed tomography, should raise suspicion that the patient may require sternotomy for safe delivery of the gland. The otolaryngologist should plan surgery for these patients in a specialist centre, with the help of a thoracic surgeon.

  • Cervicothoracic goitre: an anatomical or radiological definition? Report of 223 surgical cases

  • C Page, V Strunski
  • Journal:
    The Journal of Laryngology & Otology / Volume 121 / Issue 11 / November 2007
    Published online by Cambridge University Press:
    15 March 2007, pp. 1083-1087
    Print publication:
    November 2007
  • Objectives:

    To analyse and compare chest radiographs and cervicothoracic computed tomography scans taken prior to thyroid surgery, in order to locate and predict thoracic extension of substernal goitres.

    Method:

    This eight-year, retrospective study included 223 patients who had undergone total thyroidectomy for benign, substernal, multinodular goitres. Chest radiographs and computed tomography scans were reviewed by two physicians (a senior ENT surgeon and a senior radiologist).

    Results:

    The most frequent mode of extension was anterior or prevascular, seen in 76 per cent of cases, especially on the left side. Fifty-nine per cent of goitres did not reach the aortic arch and 11 per cent extended beyond the aortic arch. A cervical surgical approach was performed in approximately 99 per cent of cases.

    Discussion:

    Thorough examination of computed tomography scans is essential in order to identify and classify substernal goitres and to decide the best surgical procedure. A cervical surgical procedure is almost always sufficient and safe for the surgical management of substernal goitres.

    Conclusion:

    Computed tomography appears to be the best imaging modality for identifying and characterising substernal goitres. Surgical management is almost always via a cervical approach and does not differ from that used for benign cervical goitres. In the future, magnetic resonance imaging may be used; its results would need to be compared with those of computed tomography.

  • Tracheoesophageal compression associated with substernal goitre. Correlation of symptoms with cross-sectional imaging findings

  • T Mackle, J Meaney, C Timon
  • Journal:
    The Journal of Laryngology & Otology / Volume 121 / Issue 4 / April 2007
    Published online by Cambridge University Press:
    26 October 2006, pp. 358-361
    Print publication:
    April 2007

  • Objective: The aim of this study was to compare the subjective tracheoesophageal pressure symptoms associated with substernal goitres with objective cross-sectional radiographic measurements.

    Design: Patients with substernal goitre were questioned regarding tracheoesophageal compression symptoms and these data were analysed for correlation with radiographic and intra-operative findings.

    Results: Twenty-six patients were included. Patients with airway symptoms including dyspnoea, stridor and coughing were more likely to have significant tracheal narrowing on pre-operative computed tomography (CT) imaging. There was also a significant correlation between the perceived severity of lump sensation in the throat and the presence of tracheal and oesophageal displacement and retrotracheal extension of the thyroid mass.

    Conclusion: Pre-operative CT measurements of tracheal and oesophageal displacement, retrotracheal extension and the degree of tracheal compression correlate well with the presence and severity of tracheoesophageal pressure symptoms. None of the radiographic findings that are exclusive to substernal goitre (percentage of substernal mass, goitre size at the level of the thoracic inlet, ratio of goitre size to the vertebral body at the thoracic inlet and retrosternal isthmus size) had any correlation with clinical symptoms in this study.