{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T11:34:45Z","timestamp":1792755285627,"version":"4.5.0"},"reference-count":23,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,3,12]],"date-time":"2018-03-12T00:00:00Z","timestamp":1520812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,3,12]],"date-time":"2018-03-12T00:00:00Z","timestamp":1520812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Resection of massive goiters with suprahyoid, retropharyngeal, and substernal extension may not be amenable to standard approaches. This study evaluates a surgical approach allowing resection of massive goiters with minimal substernal and deep neck dissection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Cases of thyroidectomy for goiters with substernal, retropharyngeal, or suprahyoid extension at a single institution from 2006 to 2017 were reviewed. The technique involves initial complete division of the medial thyroid tracheal attachments after identification of the RLN medial\u2010inferiorly or superiorly. Deep components are then delivered into the superficial paratracheal region of the neck.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty patients were included, 46 of which had substernal and 14 had only suprahyoid or retropharyngeal extension. Mean substernal extension was 3.7\u00a0cm (range 1.5\u20137.5\u00a0cm). The medial approach was successful in identifying the RLN in 70 (83%) of 84 goiter sides (71% medial\u2010inferiorly and 29% superiorly). Standard inferior\/lateral approaches were used in 12 (14%) nerves or not found until after goiter removal in 2 (2.5%). No patients required sternotomy or tracheotomy. Complications included postoperative seroma\/hematoma (<jats:italic>n<\/jats:italic>\u2009=\u20099, 15%) with one re\u2010exploration, transient RLN injury (<jats:italic>n<\/jats:italic>\u2009=\u20094, 4% of all lobectomies), transient hypocalcemia (<jats:italic>n<\/jats:italic>\u2009=\u20096, 16% of total thyroidectomies), permanent hypocalcemia (<jats:italic>n<\/jats:italic>\u2009=\u20092, 5% of total thyroidectomies), and permanent RLN paralysis (<jats:italic>n<\/jats:italic>\u2009=\u20091, 1% of all lobectomies).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Large suprahyoid, retropharyngeal, and substernal goiters were resected transcervically with low morbidity. Early complete division of Berry\u2019s ligament after medial\u2010inferior RLN identification was achieved in a high proportion of patients, facilitating goiter delivery with minimal mediastinal and deep neck dissection.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-018-4576-z","type":"journal-article","created":{"date-parts":[[2018,3,12]],"date-time":"2018-03-12T19:20:44Z","timestamp":1520882444000},"page":"1415-1423","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Medial Approach for the Resection of Goiters with Suprahyoid, Retropharyngeal, or Substernal Extension"],"prefix":"10.1002","volume":"42","author":[{"given":"Harry H.","family":"Ching","sequence":"first","affiliation":[{"name":"Department of Otolaryngology \u2010 Head and Neck Surgery University of Nevada Las Vegas School of Medicine 1701 W Charleston Blvd, Suite 490 89102 Las Vegas NV USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob B.","family":"Kahane","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2010 Head and Neck Surgery University of Nevada Las Vegas School of Medicine 1701 W Charleston Blvd, Suite 490 89102 Las Vegas NV USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan J.","family":"Foggia","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2010 Head and Neck Surgery University of Nevada Las Vegas School of Medicine 1701 W Charleston Blvd, Suite 490 89102 Las Vegas NV USA"},{"name":"University of Nevada, Reno School of Medicine Las Vegas NV USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annabel E.","family":"Barber","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2010 Head and Neck Surgery University of Nevada Las Vegas School of Medicine 1701 W Charleston Blvd, Suite 490 89102 Las Vegas NV USA"},{"name":"Department of Surgery University of Nevada Las Vegas School of Medicine Las Vegas NV USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2010 Head and Neck Surgery University of Nevada Las Vegas School of Medicine 1701 W Charleston Blvd, Suite 490 89102 Las Vegas NV USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,3,12]]},"reference":[{"key":"e_1_2_8_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005537\u2010199811000\u201000005"},{"key":"e_1_2_8_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21246"},{"key":"e_1_2_8_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000129357.58265.3c"},{"key":"e_1_2_8_5_2","first-page":"72","article-title":"Substernal goitres\u07ddsurgical technique","volume":"5","author":"Proye C","year":"1993","journal-title":"Curr Pract Surg"},{"key":"e_1_2_8_6_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2013.0291"},{"key":"e_1_2_8_7_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215106000995"},{"key":"e_1_2_8_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0039\u20106109(16)46628\u20104"},{"key":"e_1_2_8_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2007.02.003"},{"key":"e_1_2_8_10_2","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/4357591"},{"key":"e_1_2_8_11_2","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/490390"},{"key":"e_1_2_8_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097\u20100347(199812)20:8<695::AID\u2010HED6>3.0.CO;2\u20103"},{"key":"e_1_2_8_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/019459988609400304"},{"key":"e_1_2_8_14_2","doi-asserted-by":"publisher","DOI":"10.1089\/ve.2014.0009"},{"key":"e_1_2_8_15_2","doi-asserted-by":"crossref","unstructured":"PadurAA KumarN GuruAet al. 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