Endothoracic thyroid. Indications of endothoracic approach
Abstract Introduction and objective: The incidence of endothoracic goiter among patients undergoing thyroidectomy ranges from 6% to 30%. Although the cervical approach is sufficient in most cases, the endothoracic approach may be necessary in 1-5.5% of patients. So it is advisable to anticipate it. The objective of this article is to describe the indications if this kind of approach. Synthesis: The main risk factors for performing sternotomy in cases of substernal goiter are the extension below the aortic arch and the retrotracheal or retrovascular location. The thoracic approach will be equally necessary in mediastinal ectopic goiters without connection to the cervical thyroid. The evaluation by a thoracic surgeon in cases of forgotten goitre will be recommended, as well as in patients with a history of radiotherapy or cervical surgery and suspected malignancy with extra-thyroid involvement. The choice of approach will depend on the location, the size of the mass and its relationship with the neighboring organs. Minimally invasive approaches can be safe alternatives to sternotomy or thoracotomy. The most frequent postoperative complications of endothoracic thyroid resection are typical of thyroid surgery: temporary or permanent recurrent paralysis, hypoparathyroidism, respiratory failure and postoperative bleeding. Conclusions: Up to 5% of thyroidectomies, a thoracic approach may be necessary, so it is convenient to anticipate it. The thoracic approach will be necessary in cases of goiter with extension below the arch, retrotracheal or retrovascular location and in mediastinal goiters without connection to the cervical thyroid.
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Abboud B, Sleilaty G, Mallak N, Abou Zeid H, Tabchy B. Morbidity and mortality of thyroidectomy for substernal goiter. Head Neck 2010;32(6):744–9.
Bhargav PR, Amar V, Mahilvayganan S, Nanganandadevi V. Feasibility of thoracoscopic approach for retrosternal goitre (posterior mediastinal goitre): Personal experiences of 11 cases. J Minim Access Surg 2016;12(3):240-4.
Cachovan G, Blessmann M, Schön G, Rother U, Heiland M, Stürenburg E, et al. Radiography-based score indicative for the pathogenicity of bacteria in odontogenic infections. Acta Odontol Scand. 2014 Oct;72(7):530–6.
Chen T, Dewhirst FE, Paster BJ, Tanner A, Wade W. HOMD: Human Oral Microbiome Database [Internet]. All Human Oral Microbial Taxa. 2017 [cited 2017 Nov 25]. Available from: http://www.homd.org/
Chen AY, Bernet VJ, Carty SE, Davies TF, Ganly I, Inabnet WB et al. American thyroid association statement on optimal surgical management of goiter. ThyroidOff J Am Thyroid Assoc. 2014;24(2):181–9.
Cougard P, Vanet S, Matet P, Goudet P, Viard H. Endothoracic goiter operated on by cervicosternotomy, A propos of 18 Cases. Chirurgie. 1994;120(6):309-13.
DEEP NECK INFECTION OF DENTAL ORIGIN. A CASE REPORT
Di Crescenzo V, Vitale M, Valvano L, Napolitano F, Vatrella A, Zeppa P et al. Surgical management of cervico-mediastinal goiters: Our experience and review of the literature. Int J Surg. 2016;28 Suppl 1:S47-53.
Dubost C, Roche JY, Celerier M. Intrathoracic diving goiters. Apropos of 50 cases. Ann Chir. 1973;27(6):555–66.
Erbil Y, Bozbora A, Barbaros U, Özarmagan S, Azezli A, Molvalilar S. Surgical management of substernal goiters: clinical experience of 170 cases. Surg Today. 2004;34(9):732–6.
Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D, et al. The CARE guidelines: consensus-based clinical case reporting guideline development. BMJ Case Rep [Internet]. 2013 Oct 23 [cited 2017 Nov 4];2013. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24155002
Gamblin TC, Jennings GR, Christie DB III, Thompson WM Jr, Dalton ML. Ectopic thyroid. Ann Thorac Surg. 2003;75:1952–3.
Grigoletto R, Toniato A, Piotto A, Bernante P, Bernardi C, Pagetta C et al. A case of forgotten giant goiter. Minerva Chir. 1997;52(7-8):943-8.
Hedayati N, McHenry CR, Prinz RA, DeJong SA. The clinical presentation and operative management of nodular and diffuse substernal thyroid disease/discussion. Am Surgeon Atlanta. 2002;68(3):245–8.
Houck WV, Kaplan AJ, Reed CE, Cole DJ. Intrathoracic aberrant thyroid: identification critical for appropriate operative approach. Am Surg. 1998;64(4):360–2.
Maestre JR, Bascones A, Sánchez P, Matesanz P, Aguilar L, Giménez MJ, et al. Odontogenic bacteria in periodontal disease and resistance patterns to common antibiotics used as treatment and prophylaxis in odontology in Spain. Rev Esp Quimioter [Internet]. 2007 Mar;20(1). Available from: http://www.seq.es/seq/0214-3429/20/1/61.pdf
McBain AJ, Bartolo RG, Catrenich CE, Charbonneau D, Ledder RG, Gilbert P. Growth and molecular characterization of dental plaque microcosms. J Appl Microbiol. 2003;94(4):655–64.
Makeieff M, Marlier F, Khudjadze M, Garrel R, Crampette L, Guerrier B. Les goitres plongeants. À propos de 212 cas. Ann Chir. 2000;125:18–25.
Malvemyr P, Liljeberg N, Hellström M, Muth A. Computed tomography for pre-operative evaluation of need for sternotomy in surgery for retrosternal goitre. Langenbecks Arch Surg Dtsch Ges Für Chir. 2015;400(3):293–9.
McKenzie GAG, Rook W. Is it possible to predict the need for sternotomy in patients undergoing thyroidectomy with retrosternal extension? Interact Cardiovasc Thorac Surg. 2014;19(1):139–43.
Monchik JM, Materazzi G. The necessity for a thoracic approach in thyroid surgery. Arch Surg. 2000;135:467-72.
Moran JC, Singer JA, Sardi A. Retrosternal goiter: a six-year institutional review. Am Surg. 1998;1(64):889–93.
Nóbrega LMM, Montagner F, Ribeiro AC, Mayer MAP, Gomes BPFA. Molecular Identification of Cultivable Bacteria From Infected Root Canals Associated With Acute Apical Abscess. Braz Dent J. 2016 Jun;27(3):318–24.
Nankee L, Chen H, Schneider DF, Sippel RS, Elfenbein DM. Substernal goiter: when is a sternotomy required? J Surg Res. 2015;199(1):121–5.
Netterville JL, Coleman SC, Smith JC, Smith MM, Day TA, Burkey BB. Management of substernal goiter. Laryngoscope. 1998;108(11):1611–7.
Noma S, Kanaoka M, Minami S, Sagoh T, Yamashita K, Nishimura K et al. Thyroid Masses: MR imaging and pathologic correlation. Radiology. 1988; 168(3):759-64.
Pardal-Peláez B, Pardal-Refoyo JL, Ochoa-Sangrador C, González-Serrano J, Montero-Martín J, López-Quiles J. Analysis of the prevalence of dental origin of deep neck infections. J Oral Maxillofac Surgery, Med Pathol. 2018 Mar;30(2):180–6.
Pellizzo MR. Difficult thyroidectomies. Il G Chir. 2015;36(2):49–56.
Podgaetz E, Gharagozloo F, Najam F, Sadeghi N, Margolis M, Tempesta BJ. A novel robotassisted technique for excision of a posterior mediastinal thyroid goiter: a combined cervico-mediastinal approach. Innovations (Phila). 2009;4(4):225-8.
Randolph GW, Kamani D. The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: voice, vocal cord function and the preoperative detection of invasive thyroid malignancy. Surg 2006;139(3):357–62.
Rea F, Schiavon M, Di Chiara F, Marulli G. Single-institution experience on robot-assisted thoracoscopic operations for mediastinal diseases. Innovations (Phila). 2011;6 (5):316-22.
Ribet M. Retrotracheal mediastinal goiter with controlateral extension. Ann Thorac Surg. 1990; 50(4):684.
Rodriguez JM, Hernandez Q, Pinero A, Ortiz S. Substernal goiter: clinical experience of 72 cases. Ann Otol Rhinol Laryngol. 1999;108(5):501–4.
Sand ME, Laws HL, McElvein RB. Substernal and intrathoracic goiter. Reconsideration of surgical approach. Am Surg. 1983;49(4):196–202.
Shigemura N, Akashi A, Nakagiri T, Matsuda H. VATS with a supraclavicular window for huge substernal goiter: an alternative technique for preventing recurrent laryngeal nerve injury. Thorac Cardiovasc Surg. 2005;53 (4):231-3.
Tek M, Metin M, Sener I, Bereket C, Tokac M, Kazancioglu HO, et al. The predominant bacteria isolated from radicular cysts. Head Face Med [Internet]. 2013 Sep;9(1):25. Available from: http://head-face-med.biomedcentral.com/articles/10.1186/1746-160X-9-25
Testini M, Gurrado A, Bellantone R, Brazzarola P, Cortese R, De Toma G, et al. Recurrent laryngeal nerve palsy and substernal goiter. An Italian multicenterstudy. J Visc Surg. 2014;151(3):183–9.
Torre G, Borgonovo G, Amato A, Arezzo A, Ansaldo G, De Negri A et al. Surgical management of substernal goiter: analysis of 237 patients. Am Surg. 1995;61:826–31.
Vadasz P, Kotsis L. Surgical aspects of 175 mediastinal goiters, Eur. J. Cardiothorac. Surg. 1998;14:393-7.
Veronesi G, Leo F, Solli PG, D’Aiuto M, D’Ovidio F, Mazzarol G et al. Life-threatening giant mediastinal goiter: a surgical challenge. J Cardiovascular Surg. 2001;42(3):429–30.
Wang S, Xu S, Liu B. Resection of huge retrosternal goiter through a novel combined cervical and robot-assisted approach. Artif Organs. 2014;38 (5):431-3.
Yanagisawa M, Kuriyama T, Williams DW, Nakagawa K, Karasawa T. Proteinase activity of prevotella species associated with oral purulent infection. Curr Microbiol. 2006 May;52(5):375–8.
Bhargav PR, Amar V, Mahilvayganan S, Nanganandadevi V. Feasibility of thoracoscopic approach for retrosternal goitre (posterior mediastinal goitre): Personal experiences of 11 cases. J Minim Access Surg 2016;12(3):240-4.
Cachovan G, Blessmann M, Schön G, Rother U, Heiland M, Stürenburg E, et al. Radiography-based score indicative for the pathogenicity of bacteria in odontogenic infections. Acta Odontol Scand. 2014 Oct;72(7):530–6.
Chen T, Dewhirst FE, Paster BJ, Tanner A, Wade W. HOMD: Human Oral Microbiome Database [Internet]. All Human Oral Microbial Taxa. 2017 [cited 2017 Nov 25]. Available from: http://www.homd.org/
Chen AY, Bernet VJ, Carty SE, Davies TF, Ganly I, Inabnet WB et al. American thyroid association statement on optimal surgical management of goiter. ThyroidOff J Am Thyroid Assoc. 2014;24(2):181–9.
Cougard P, Vanet S, Matet P, Goudet P, Viard H. Endothoracic goiter operated on by cervicosternotomy, A propos of 18 Cases. Chirurgie. 1994;120(6):309-13.
DEEP NECK INFECTION OF DENTAL ORIGIN. A CASE REPORT
Di Crescenzo V, Vitale M, Valvano L, Napolitano F, Vatrella A, Zeppa P et al. Surgical management of cervico-mediastinal goiters: Our experience and review of the literature. Int J Surg. 2016;28 Suppl 1:S47-53.
Dubost C, Roche JY, Celerier M. Intrathoracic diving goiters. Apropos of 50 cases. Ann Chir. 1973;27(6):555–66.
Erbil Y, Bozbora A, Barbaros U, Özarmagan S, Azezli A, Molvalilar S. Surgical management of substernal goiters: clinical experience of 170 cases. Surg Today. 2004;34(9):732–6.
Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D, et al. The CARE guidelines: consensus-based clinical case reporting guideline development. BMJ Case Rep [Internet]. 2013 Oct 23 [cited 2017 Nov 4];2013. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24155002
Gamblin TC, Jennings GR, Christie DB III, Thompson WM Jr, Dalton ML. Ectopic thyroid. Ann Thorac Surg. 2003;75:1952–3.
Grigoletto R, Toniato A, Piotto A, Bernante P, Bernardi C, Pagetta C et al. A case of forgotten giant goiter. Minerva Chir. 1997;52(7-8):943-8.
Hedayati N, McHenry CR, Prinz RA, DeJong SA. The clinical presentation and operative management of nodular and diffuse substernal thyroid disease/discussion. Am Surgeon Atlanta. 2002;68(3):245–8.
Houck WV, Kaplan AJ, Reed CE, Cole DJ. Intrathoracic aberrant thyroid: identification critical for appropriate operative approach. Am Surg. 1998;64(4):360–2.
Maestre JR, Bascones A, Sánchez P, Matesanz P, Aguilar L, Giménez MJ, et al. Odontogenic bacteria in periodontal disease and resistance patterns to common antibiotics used as treatment and prophylaxis in odontology in Spain. Rev Esp Quimioter [Internet]. 2007 Mar;20(1). Available from: http://www.seq.es/seq/0214-3429/20/1/61.pdf
McBain AJ, Bartolo RG, Catrenich CE, Charbonneau D, Ledder RG, Gilbert P. Growth and molecular characterization of dental plaque microcosms. J Appl Microbiol. 2003;94(4):655–64.
Makeieff M, Marlier F, Khudjadze M, Garrel R, Crampette L, Guerrier B. Les goitres plongeants. À propos de 212 cas. Ann Chir. 2000;125:18–25.
Malvemyr P, Liljeberg N, Hellström M, Muth A. Computed tomography for pre-operative evaluation of need for sternotomy in surgery for retrosternal goitre. Langenbecks Arch Surg Dtsch Ges Für Chir. 2015;400(3):293–9.
McKenzie GAG, Rook W. Is it possible to predict the need for sternotomy in patients undergoing thyroidectomy with retrosternal extension? Interact Cardiovasc Thorac Surg. 2014;19(1):139–43.
Monchik JM, Materazzi G. The necessity for a thoracic approach in thyroid surgery. Arch Surg. 2000;135:467-72.
Moran JC, Singer JA, Sardi A. Retrosternal goiter: a six-year institutional review. Am Surg. 1998;1(64):889–93.
Nóbrega LMM, Montagner F, Ribeiro AC, Mayer MAP, Gomes BPFA. Molecular Identification of Cultivable Bacteria From Infected Root Canals Associated With Acute Apical Abscess. Braz Dent J. 2016 Jun;27(3):318–24.
Nankee L, Chen H, Schneider DF, Sippel RS, Elfenbein DM. Substernal goiter: when is a sternotomy required? J Surg Res. 2015;199(1):121–5.
Netterville JL, Coleman SC, Smith JC, Smith MM, Day TA, Burkey BB. Management of substernal goiter. Laryngoscope. 1998;108(11):1611–7.
Noma S, Kanaoka M, Minami S, Sagoh T, Yamashita K, Nishimura K et al. Thyroid Masses: MR imaging and pathologic correlation. Radiology. 1988; 168(3):759-64.
Pardal-Peláez B, Pardal-Refoyo JL, Ochoa-Sangrador C, González-Serrano J, Montero-Martín J, López-Quiles J. Analysis of the prevalence of dental origin of deep neck infections. J Oral Maxillofac Surgery, Med Pathol. 2018 Mar;30(2):180–6.
Pellizzo MR. Difficult thyroidectomies. Il G Chir. 2015;36(2):49–56.
Podgaetz E, Gharagozloo F, Najam F, Sadeghi N, Margolis M, Tempesta BJ. A novel robotassisted technique for excision of a posterior mediastinal thyroid goiter: a combined cervico-mediastinal approach. Innovations (Phila). 2009;4(4):225-8.
Randolph GW, Kamani D. The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: voice, vocal cord function and the preoperative detection of invasive thyroid malignancy. Surg 2006;139(3):357–62.
Rea F, Schiavon M, Di Chiara F, Marulli G. Single-institution experience on robot-assisted thoracoscopic operations for mediastinal diseases. Innovations (Phila). 2011;6 (5):316-22.
Ribet M. Retrotracheal mediastinal goiter with controlateral extension. Ann Thorac Surg. 1990; 50(4):684.
Rodriguez JM, Hernandez Q, Pinero A, Ortiz S. Substernal goiter: clinical experience of 72 cases. Ann Otol Rhinol Laryngol. 1999;108(5):501–4.
Sand ME, Laws HL, McElvein RB. Substernal and intrathoracic goiter. Reconsideration of surgical approach. Am Surg. 1983;49(4):196–202.
Shigemura N, Akashi A, Nakagiri T, Matsuda H. VATS with a supraclavicular window for huge substernal goiter: an alternative technique for preventing recurrent laryngeal nerve injury. Thorac Cardiovasc Surg. 2005;53 (4):231-3.
Tek M, Metin M, Sener I, Bereket C, Tokac M, Kazancioglu HO, et al. The predominant bacteria isolated from radicular cysts. Head Face Med [Internet]. 2013 Sep;9(1):25. Available from: http://head-face-med.biomedcentral.com/articles/10.1186/1746-160X-9-25
Testini M, Gurrado A, Bellantone R, Brazzarola P, Cortese R, De Toma G, et al. Recurrent laryngeal nerve palsy and substernal goiter. An Italian multicenterstudy. J Visc Surg. 2014;151(3):183–9.
Torre G, Borgonovo G, Amato A, Arezzo A, Ansaldo G, De Negri A et al. Surgical management of substernal goiter: analysis of 237 patients. Am Surg. 1995;61:826–31.
Vadasz P, Kotsis L. Surgical aspects of 175 mediastinal goiters, Eur. J. Cardiothorac. Surg. 1998;14:393-7.
Veronesi G, Leo F, Solli PG, D’Aiuto M, D’Ovidio F, Mazzarol G et al. Life-threatening giant mediastinal goiter: a surgical challenge. J Cardiovascular Surg. 2001;42(3):429–30.
Wang S, Xu S, Liu B. Resection of huge retrosternal goiter through a novel combined cervical and robot-assisted approach. Artif Organs. 2014;38 (5):431-3.
Yanagisawa M, Kuriyama T, Williams DW, Nakagawa K, Karasawa T. Proteinase activity of prevotella species associated with oral purulent infection. Curr Microbiol. 2006 May;52(5):375–8.
Jiménez-López, M. F., & Gómez-Hernández, M. T. (2019). Endothoracic thyroid. Indications of endothoracic approach. Revista ORL, 11(2), 217–223. https://doi.org/10.14201/orl.21595
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