Sternotomy for substernal goitre: An otolaryngologist's perspective

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.