Retrosternal goitre, do humans need a sternotomy?

Abstract

Retrosternal goitre as a surgical thyroid pathology is diminishing in incidence. Though surgery is the generally accepted treatment modality, lot of uncertainties exist regarding the approach for surgery in consideration with the prognostication, surgical morbidity and the post-operative outcome. Median sternotomy, in addition to being more morbid, is generally out of the general surgeons’ perview and therefore its need necessitates preoperative arrangements for assistance by a thoracic surgeon. Cervical approach is sufficient for most of the lesions but the surgeon should be conversant with median sternotomy as to perform it expediently and without hesitation when it is indicated. The generally indications for sternotomy are extension of goitre below the aortic arch, involvement of the posterior mediastinum, large thyroid tissue extending towards tracheal bifurcation, and primary ectopic thyroid tissue in the mediastinum. Here the available literature was reviewed to identify the preoperative predictors of a sternotomy in the management of substernal goitre in order to provide better preoperative planning and patient consent in managing the patient with reference to a recently encountered case.