title: A limited thoracocervical approach for accessing the anterior mediastinum in retrosternal goiters: Surgical technique and implications for the management of head and neck emergencies.
abstract: In this article we describe the surgical management of retrosternal goiters via a limited thoracocervical approach, and we explore how the respective surgical know-how can be used in the management of the carotid blowout syndrome. Four cases involving patients who had undergone thyroidectomy via a limited thoracocervical approach are retrospectively reviewed. An acute blowout of the innominate artery managed with the same principal surgical technique is also reviewed. Three patients had a total thyroidectomy and one had a hemithyroidectomy. No malignancy was found. There was no mortality or unexpected morbidity from the limited thoracocervical approach. The median length of the inpatient stay was 3 days. The blowout survivor lived for 9 months, with no rebleeding and with an acceptable quality of life. We conclude that a limited thoracocervical approach can be safely performed by head and neck surgeons for accessing the anterior mediastinum in retrosternal goiters, and the respective surgical know-how can be used in the immediate management of an acute carotid blowout syndrome with satisfying long-term results and provision of quality end-of-life care.
authors.affiliation: ENT Department, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire, UK SG1 4AB. pevlast@hotmail.com.
authors.forename: Petros V
authors.initials: PV
authors.lastname: Vlastarakos
authors.forename: Aaron
authors.initials: A
authors.lastname: Trinidade
authors.forename: Marie-Claire
authors.initials: MC
authors.lastname: Jaberoo
authors.forename: George
authors.initials: G
authors.lastname: Mochloulis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000209:etiology / Q000601:surgery; D004630:Emergencies; D005260:Female; D006045:Goiter, Substernal / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D008481:Mediastinoscopy / Q000379:methods*; D008482:Mediastinum / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D013965:Thyroidectomy / Q000379:methods*