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Cervico-mediastinal Goiter: The Clinical and Therapeutic Aspects

Received: 13 July 2022    Accepted: 29 July 2022    Published: 10 August 2022
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Abstract

OBJECTIVES: Our work aimed to expose the methods of resection of plunging goiters by pure cervicotomy and to compare the results of our study with those of the literature. MATERIAL AND METHODS: This was a retrospective study extended over 5 years from January 2016 to December 2020 on the medical observations of 20 cases of thyroidectomy for plunging goiters in the otolaryngology and cervicofacial surgery department of the Gabriel Touré University Hospital of Bamako. RESULTS: During our study period, 170 cases of thyroidectomies were performed in the department, including 20 cases of plunging goiters, i.e. (11.76%) surgical goiters. The average age was 43.5 years with extremes ranging from 20 to 80 years. The age group of 40 to 50 years was the most represented. We noted a female predominance with a sex ratio of 0.25. Six patients (30%) had a family history of goiter. The average duration of evolution of goiter was 8 years with extremes ranging from 2 to 17 years. The lower edge of the goiter was not palpable in any of our patients. Chest X-ray was performed in all patients and showed greater mediatisnal opacity in 11 patients (55%), tracheal deviation in 7 patients (35%), and tracheal compression in 2 patients (10%). Cervicothoracic computed tomography was performed in 18 patients, i.e. 90% of cases. The anterior location represented 85% and the posterior location 15%. Plasma thyrocalcitonin was measured in 3 patients, i.e. 15%. All the goiters were extirpated exclusively by the cervical route. Our patients benefited from a total thyroidectomy in 70% of cases (n = 14), a subtotal thyroidectomy in 20% of cases (n = 4) and a lobo-isthmectomy for 10% of patients (n = 2). Dissection of the recurrent nerve was performed retrogradely at its entry point into the larynx in all patients. Accidental devascularization of the lower parathyroids was noted in three patients (15%) and infiltration of the upper parathyroids was noted in 1 patient (5%). Reoperation for totalization was performed in one patient (5%). Lymph node dissection was performed in two cases (10%). Post surgery radiotherapy was performed in two cases (10%). Clinical and biological monitoring was normal in our patients.

Published in International Journal of Otorhinolaryngology (Volume 8, Issue 2)
DOI 10.11648/j.ijo.20220802.14
Page(s) 46-51
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Cervico-mediasttinal Goiter, Recurrent Nerve, Cervicotomy

References
[1] P. YAPO, S. F. EHUA, K. G. SORO. Traitement chirurgical des goitres plongeants: à propos de 27 patients [Surgical treatment of plunging goiters: about 27 patients.]. j.jchir.2009.05.011.
[2] M. MAKEIEFF, F MARLIER, M KHUDJADZE. Les goitres plongeants, à propos de 212 cas [Plunging goiters, about 212 cases]. Ann chir 2000; 125: 18-25.
[3] BEN AMOR M, DHAMBRI S, HARIGA I, ABID W, HANNACHI R, BEN GAMRA O et al. Les goitres plongeants: Particularités cliniques, radiologiques et thérapeutiques [Plunging goiters: Clinical, radiological and therapeutic particularities]. J. Tun ORL 2014 (n°31), 27- 29.
[4] BRENET E, ET al. Assessment and management of cervico-mediastinal goiter. European Annals of Otorhinolaryngology, Head and Neck diseases (2017), http://dx.doi.org/10.1016/j.anorl.2017.06.001
[5] WHITE ML, DOHERTY GM, GAUGER PG. Evidence based surgical management of substernal goiter. World J Surg 2008; 32: 1285–300.
[6] SINGH B, LUCENTE F, SHAHA AR. Substernal goiter: a clinical review. Am J Otola-ryngol 1994; 15: 409–16.
[7] TESTINI M ET al. Does mediastinal extension of the goiter increase morbidity of total thyroidectomy? A multicenter study of 19, 662 patients. Ann SurgOncol. 2011; 18 (8): 22519.
[8] RAZAFIMANJATO NNM, RAVOATRARILANDY M, RALIJAONA H, et al. Les goitres plongeants: aspects chirurgicaux à Madagascar [Plunging goiters: surgical aspects in Madagascar]. Batna J Med Sci 2017; 4: 21-26.
[9] KRAIMPS JL, GINESTE D, GAUTHIER JB, BENAND P. Goiter plongeant: 100 cas. Lyon Chir 1990; 86: 455–7.
[10] MERLIER M, ESCHAPASSE A. Les goitres à développement thoracique [Chest-developing goiters]. Les cahiers Baillère; édition Paris; 1972.
[11] M. BENBAKH, M. ABOU-ELFADL, S. ROUADI. Goitres plongeants: expérience du service à propos de 50 cas [Plunging goiters: experience of the service apropos of 50 cases]. Annales françaises d’oto-rhino-laryngologie et de pathologie cervico-faciale 133 (2016) 17–20.
[12] N. ROMDHANE et al. Goitre plongeant: Particularités cliniques et thérapeutiques [Sub-sternal goitre: Clinical and therapeutic features]. J. TUN ORL - No 47 MARS 2022.
[13] S. KDOUS Goitres plongeants: apport de l’imagerie médicale: à propos de 60 cas [Plunging goiters: contribution of medical imaging: about 60 cases] SFE Bordeaux 2016 / Annales d’Endocrinologie 77 (2016) 372–412.
[14] Ho TWT, SHAHEEN AA, DIXON E, HARVEY A. Utilization of thyroidectomy forbenign disease in the United States: a 15-year population-based study. Am JSurg 2011; 201 (5): 570–4.
[15] PIERACCI FM, FAHEY TJ. Effect of hospital volume of thyroidectomies on outcomes following substernal thyroidectomy. World J Surg 2008; 32 (5): 740–6.
[16] MACKIE TW, SKINNER A. Anaesthesia for massive retrosternal thyroidectomy ina tertiary referral centre. Br J Anaesth 2014; 112 (4): 756.
[17] TRAN BA HUY P, KANIA R Thyroïdectomie [Thyroidectomy]. Encyclopédie Médico-Chirurgicale 46-460 (2004).
[18] S, I., DIDIE L, J., I, B., & RACHID, S. (2016). Les Goitres Plongeants: Aspects Épidémiologiques, Cliniques, Radiologiques Et Thérapeutiques [Plunging Goiters: Epidemiological, Clinical, Radiological and Therapeutic Aspects]. European Scientific Journal, ESJ, 12 (30), 305. https://doi.org/10.19044/esj.2016.v12n30p305
[19] RIDAL MOHAMMED, ABBASI HASSAN, AISSAOUI FOUAD. La prise en charge d’un goitre compressif chez une femme enceinte [The management of a compressive goiter in a pregnant woman]. LA TUNISIE MEDICALE - 2015; Vol 93 (n°03).
[20] KRAHENBUHL, T., ANCHISI, S., PORTMANN, L., Cancers différenciés de la thyroïde: prise en charge et place des nouvelles thérapies ciblées [Differentiated thyroid cancers: management and role of new targeted therapies], Rev Med Suisse, 2012/342 (Vol.-2), p. 1112–1117. URL: https://www.revmed.ch/revue-medicale-suisse/2012/revue-medicale-suisse-342/cancers-differencies-de-la-thyroide-prise-en-charge-et-place-des-nouvelles-therapies-ciblees
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    N’faly Konate, Kassim Diarra, Yaya Dembele, Kalifa Coulibaly, Fatogoma Issa Kone, et al. (2022). Cervico-mediastinal Goiter: The Clinical and Therapeutic Aspects. International Journal of Otorhinolaryngology, 8(2), 46-51. https://doi.org/10.11648/j.ijo.20220802.14

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    ACS Style

    N’faly Konate; Kassim Diarra; Yaya Dembele; Kalifa Coulibaly; Fatogoma Issa Kone, et al. Cervico-mediastinal Goiter: The Clinical and Therapeutic Aspects. Int. J. Otorhinolaryngol. 2022, 8(2), 46-51. doi: 10.11648/j.ijo.20220802.14

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    AMA Style

    N’faly Konate, Kassim Diarra, Yaya Dembele, Kalifa Coulibaly, Fatogoma Issa Kone, et al. Cervico-mediastinal Goiter: The Clinical and Therapeutic Aspects. Int J Otorhinolaryngol. 2022;8(2):46-51. doi: 10.11648/j.ijo.20220802.14

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  • @article{10.11648/j.ijo.20220802.14,
      author = {N’faly Konate and Kassim Diarra and Yaya Dembele and Kalifa Coulibaly and Fatogoma Issa Kone and Naouma Cisse and Boubacary Guindo and Youssouf Sidibe and Siaka Soumaoro and Kadiatou Sinkare and Mohamed Keita},
      title = {Cervico-mediastinal Goiter: The Clinical and Therapeutic Aspects},
      journal = {International Journal of Otorhinolaryngology},
      volume = {8},
      number = {2},
      pages = {46-51},
      doi = {10.11648/j.ijo.20220802.14},
      url = {https://doi.org/10.11648/j.ijo.20220802.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijo.20220802.14},
      abstract = {OBJECTIVES: Our work aimed to expose the methods of resection of plunging goiters by pure cervicotomy and to compare the results of our study with those of the literature. MATERIAL AND METHODS: This was a retrospective study extended over 5 years from January 2016 to December 2020 on the medical observations of 20 cases of thyroidectomy for plunging goiters in the otolaryngology and cervicofacial surgery department of the Gabriel Touré University Hospital of Bamako. RESULTS: During our study period, 170 cases of thyroidectomies were performed in the department, including 20 cases of plunging goiters, i.e. (11.76%) surgical goiters. The average age was 43.5 years with extremes ranging from 20 to 80 years. The age group of 40 to 50 years was the most represented. We noted a female predominance with a sex ratio of 0.25. Six patients (30%) had a family history of goiter. The average duration of evolution of goiter was 8 years with extremes ranging from 2 to 17 years. The lower edge of the goiter was not palpable in any of our patients. Chest X-ray was performed in all patients and showed greater mediatisnal opacity in 11 patients (55%), tracheal deviation in 7 patients (35%), and tracheal compression in 2 patients (10%). Cervicothoracic computed tomography was performed in 18 patients, i.e. 90% of cases. The anterior location represented 85% and the posterior location 15%. Plasma thyrocalcitonin was measured in 3 patients, i.e. 15%. All the goiters were extirpated exclusively by the cervical route. Our patients benefited from a total thyroidectomy in 70% of cases (n = 14), a subtotal thyroidectomy in 20% of cases (n = 4) and a lobo-isthmectomy for 10% of patients (n = 2). Dissection of the recurrent nerve was performed retrogradely at its entry point into the larynx in all patients. Accidental devascularization of the lower parathyroids was noted in three patients (15%) and infiltration of the upper parathyroids was noted in 1 patient (5%). Reoperation for totalization was performed in one patient (5%). Lymph node dissection was performed in two cases (10%). Post surgery radiotherapy was performed in two cases (10%). Clinical and biological monitoring was normal in our patients.},
     year = {2022}
    }
    

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  • TY  - JOUR
    T1  - Cervico-mediastinal Goiter: The Clinical and Therapeutic Aspects
    AU  - N’faly Konate
    AU  - Kassim Diarra
    AU  - Yaya Dembele
    AU  - Kalifa Coulibaly
    AU  - Fatogoma Issa Kone
    AU  - Naouma Cisse
    AU  - Boubacary Guindo
    AU  - Youssouf Sidibe
    AU  - Siaka Soumaoro
    AU  - Kadiatou Sinkare
    AU  - Mohamed Keita
    Y1  - 2022/08/10
    PY  - 2022
    N1  - https://doi.org/10.11648/j.ijo.20220802.14
    DO  - 10.11648/j.ijo.20220802.14
    T2  - International Journal of Otorhinolaryngology
    JF  - International Journal of Otorhinolaryngology
    JO  - International Journal of Otorhinolaryngology
    SP  - 46
    EP  - 51
    PB  - Science Publishing Group
    SN  - 2472-2413
    UR  - https://doi.org/10.11648/j.ijo.20220802.14
    AB  - OBJECTIVES: Our work aimed to expose the methods of resection of plunging goiters by pure cervicotomy and to compare the results of our study with those of the literature. MATERIAL AND METHODS: This was a retrospective study extended over 5 years from January 2016 to December 2020 on the medical observations of 20 cases of thyroidectomy for plunging goiters in the otolaryngology and cervicofacial surgery department of the Gabriel Touré University Hospital of Bamako. RESULTS: During our study period, 170 cases of thyroidectomies were performed in the department, including 20 cases of plunging goiters, i.e. (11.76%) surgical goiters. The average age was 43.5 years with extremes ranging from 20 to 80 years. The age group of 40 to 50 years was the most represented. We noted a female predominance with a sex ratio of 0.25. Six patients (30%) had a family history of goiter. The average duration of evolution of goiter was 8 years with extremes ranging from 2 to 17 years. The lower edge of the goiter was not palpable in any of our patients. Chest X-ray was performed in all patients and showed greater mediatisnal opacity in 11 patients (55%), tracheal deviation in 7 patients (35%), and tracheal compression in 2 patients (10%). Cervicothoracic computed tomography was performed in 18 patients, i.e. 90% of cases. The anterior location represented 85% and the posterior location 15%. Plasma thyrocalcitonin was measured in 3 patients, i.e. 15%. All the goiters were extirpated exclusively by the cervical route. Our patients benefited from a total thyroidectomy in 70% of cases (n = 14), a subtotal thyroidectomy in 20% of cases (n = 4) and a lobo-isthmectomy for 10% of patients (n = 2). Dissection of the recurrent nerve was performed retrogradely at its entry point into the larynx in all patients. Accidental devascularization of the lower parathyroids was noted in three patients (15%) and infiltration of the upper parathyroids was noted in 1 patient (5%). Reoperation for totalization was performed in one patient (5%). Lymph node dissection was performed in two cases (10%). Post surgery radiotherapy was performed in two cases (10%). Clinical and biological monitoring was normal in our patients.
    VL  - 8
    IS  - 2
    ER  - 

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Author Information
  • ENT and Head and Neck Surgery Department, University Hospital Center “Gabriel Toure”, Bamako, Mali

  • ENT and Head and Neck Surgery Department, University Hospital Center “Gabriel Toure”, Bamako, Mali

  • ENT and Head and Neck Surgery Department, University Hospital Center “Luxembourg”, Bamako, Mali

  • ENT and Head and Neck Surgery Department, University Hospital Center “Gabriel Toure”, Bamako, Mali

  • ENT and Head and Neck Surgery Department, University Hospital Center “Gabriel Toure”, Bamako, Mali

  • ENT and Head and Neck Surgery Department, University Hospital Center “Gabriel Toure”, Bamako, Mali

  • ENT and Head and Neck Surgery Department, University Hospital Center “Gabriel Toure”, Bamako, Mali

  • ENT and Head and Neck Surgery Department, Army Polyclinic Kati Mali, Kati, Mali

  • ENT and Head and Neck Surgery Department, University Hospital Center “Gabriel Toure”, Bamako, Mali

  • ENT and Head and Neck Surgery Department, University Hospital Center “Gabriel Toure”, Bamako, Mali

  • ENT and Head and Neck Surgery Department, University Hospital Center “Gabriel Toure”, Bamako, Mali

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