Cervical approach to cervico-mediastinal goiters: Experience of a Moroccan ENT tertiary center - Case series.
Ann Med Surg (Lond) 2021;
62:353-357. [PMID:
33552494 PMCID:
PMC7848720 DOI:
10.1016/j.amsu.2021.01.081]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 12/01/2022] Open
Abstract
Background
The purpose of the study was to analyze and discuss the demographic, clinical, radiological, therapeutic and postoperative findings of the Cervico-mediastinal goiters (CMG) treated through a cervical approach admitted in the ENT department of Ibn Rochd university hospital, Casablanca, Morocco between January 2014 and January 2020.
Materiels and methods
Over a period of 6 years, 116 patients underwent surgical treatment for CMG. It was defined as a goiter extending below the plane of superior thoracic aperture on CT scan. All our patients had clinical, biological and radiological assessment before surgery. A nasofibroscopy was carried out pre and postoperatively. All the CMG have been extracted trough a cervical approach by an experimented ENT surgeon.
Results
84,48% of the CMG was diving into the anterior mediastinum and 15.52% into the posterior. The CMGs extended above, at, and below the level of the aortic arch respectively in 76.72%, 18.10% and 5.17% of the patients. All of 116 goiters were successfully removed through a cervical approach. No patient required a sternotomy. Postoperatively, vocal cord paralysis was transient in 3 patients (2.58%) and permanent in 2 patients (1.72%). Hypocalcemia was transient in 10 patients (8.62%) and permanent in 2 patients (1.72%). Final histology found 106 benign multinodular goiters (91.37%), 7 papillary carcinomas (6.03%) and 3 vesicular carcinomas (2.58%). No death was noted.
Conclusions
With expertise in thyroid surgery, cervical approach for CMGs is safe and sufficient in the majority of the cases with low morbidity rate and no mortality.
In the literature, there is no consensus on the definition of cervico-mediastinal goiters.
CMG is a challenging disease that needs proper clinical, biological and radiological assessment.
Malignancy in a CMG is not higher than that of the cervical goiters and most of the foci in CMG were in the intrathoracic region.
With expertise in thyroid surgery, cervical approach for CMGs is safe and sufficient in the majority of the cases.
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