title: Substernal goiters and sternotomy.
abstract: OBJECTIVE
  To determine what factors predispose patients with retrosternal goiters to median sternotomy.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Analysis of a single surgeon experience with 113 substernal goiters operated upon during a 10-year period.
  
  
  RESULTS
  108 goiters were successfully removed through a cervical approach. Four patients required sternotomy, and it was concluded that one patient who did not receive sternotomy might have been better managed with sternotomy. Factors that led to sternotomy were malignancy, involvement of the posterior mediastinum, extensive substernal extension, and the presence of an ectopic nodule. The latter two were the most important factors. Revision surgery and tracheal compression did not influence the need for sternotomy.
  
  
  CONCLUSIONS
  On the basis of preoperative imaging, it is possible to predict which patients with retrosternal goiters are likely to require median sternotomy. These factors are malignancy, extension into the posterior mediastinum, substernal extension inferior to the level of the aortic arch, and the lack of a solid attachment between the cervical and mediastinal components of the thyroid gland. Although previously reported, the latter factor has not received sufficient recognition in the management of retrosternal goiter.
authors.affiliation: Vassar Brothers Medical Center Head & Neck Institute, Department of Otolaryngology-HNS, NYU Langone Medical Center, New York, New York, USA. jpc.sdc@gmail.com
authors.forename: Jason P
authors.initials: JP
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006045:Goiter, Substernal / Q000453:epidemiology / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods* / Q000706:statistics & numerical data*