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CHIRURGIA

A Journal on Surgery


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Chirurgia 2005 April;18(2):61-4

language: Italian

Substernal goiters

Proye C., Ippolito G., Moreno S., Montoya G.


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A substernal goiter may be defined as one lying 4 fingerbreadths below the sternal notch. On the antero-posterior chest X-ray this corresponds to a goiter which lies at the lower border of the 2nd thoracic vertebra. Goiters usually become substernal as a result of gravity. They are rarely seen before the age of 40 and are rarely malignant. All substernal goiters must be removed because they can cause respiratory complications. The great majority of substernal goiters can be resected via neck approach with good positioning and an adequate incision. Blind resection techniques should be avoided. The Toboggan technique should be used, starting by the mobilization of the isthmus followed by intercrico-thyroid dissection, ligation of the branches of the superior vascular pedicle, identification of the superior parathyroid and of the recurrent laryngeal nerve at its ending in the crico-thyroid membrane for retrograde dissection towards the thoracic inlet. Finally, removal of the goiter by direct visualization of the inferior venous pedicle. Thoracic approach has limited indications, but when indicated cervicotomy combined with sternotomy is the best approach for anterior mediastinum, combined with antero-lateral thoracotomy for the right anterior substernal goiters, combined with postero-lateral thoracotomy for the posterior substernal goiters.

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