Difficulties in the Choice of Surgical Approach in Cervicothoracic Goiters

Introduction: Indications for thoracotomy or sternotomy are very rare or exceptional in surgery plunging goiter. Through our experience about 10 patients we wanted to discuss the difficulty in choosing the surgical approach to this rare condition. Materials and Methods: This is a retrospective descriptive study covering the period January 2009 to June 2016, in the thoracic surgery department in CHU Hassan II of Fes, the inclusion criteria were: the location of the cervico thoracic goiter, his preoperatively euthyroid character but also its benign nature based on the results of the radiological assessment including the CT scan. Results: In total 8 women and 2 men were involved in the study. A notion of prior thyroid surgery was noted in 3 patients. Computed tomography confirmed the plunging goiter character in among 10 patients who had back-vascular goiter in 55% of cases. The incision was thoracotomy in 2 cases, cervicotomy in 3 cases. The cervicotomy-manubriotomy and cervicotomy-thoracotomy association was performed in 2 cases each. In one patient who had a goiter complex, an indication of a first triple by-manubriotomy cervicotomy thoracotomy was necessary. In immediate post-operative, one patient had a cervical hematoma requiring surgical revision. Other complications were dominated by recurrent laryngeal paralysis in 2 cases and postoperative hypocalcemia in 5 cases. Conclusion: The surgery of cervico thoracic goiters is conceivable that after a complete mapping of the lesion using a suitable radiological assessment. The indication of a trans-sternal or thoracotomy approach should be discussed in a posterior ineradicable by cervicotomy or in suspected neoplasia.