{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:41:49Z","timestamp":1792644109447,"version":"4.5.0"},"reference-count":26,"publisher":"International College of Surgeons","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014]]},"abstract":"<jats:title>Abstract<\/jats:title>\n        <jats:p>The presence of substernal goiter is, per se, an indication for surgical management. Surgical approach of substernal goiter can most commonly be performed using the cervical access, but at times, a sternotomy or thoracotomy is necessary. The aim of this study was to identify the preoperative predictors of a sternotomy in the management of substernal goiter in order to provide better preoperative planning and patient consent. Between 2005 and 2012, 665 patients were referred to our clinic for thyroidectomy, 42 patients (6.3%) had substernal goiter and were included in this study. All substernal goiters were treated surgically, 38 (90.5%) by a cervical approach and 4 (9.5%) by full median sternotomy. All surgeries were successful, with no major postoperative complications. Minor postoperative complications of transient hypocalcemia and transient paralysis of the recurrent laryngeal nerve occurred in 5 (11.9%) and 2 (4.7%) cases, respectively. Indication of median sternotomy was as follows: extension of goiter below the aortic arch, large thyroid tissue extending towards tracheal bifurcation, and ectopic thyroid tissue in the mediastinum. Substernal goiter can be removed through a cervical incision, but on rare occasions, a median sternotomy may be required.<\/jats:p>","DOI":"10.9738\/intsurg-d-14-00041.1","type":"journal-article","created":{"date-parts":[[2014,7,24]],"date-time":"2014-07-24T19:24:38Z","timestamp":1406229878000},"page":"419-425","source":"Crossref","is-referenced-by-count":52,"title":["Substernal Goiter: When is a Sternotomy Required?"],"prefix":"10.9738","volume":"99","author":[{"given":"Ali","family":"Coskun","sequence":"first","affiliation":[{"name":"Izmir Bozyaka Training and Research Hospital, Department of Surgery, Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet","family":"Yildirim","sequence":"additional","affiliation":[{"name":"Izmir Bozyaka Training and Research Hospital, Department of Surgery, Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazif","family":"Erkan","sequence":"additional","affiliation":[{"name":"Izmir Bozyaka Training and Research Hospital, Department of Surgery, Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4721","reference":[{"issue":"1","key":"i0020-8868-99-4-419-b01","series-title":"Int Surg","first-page":"71","article-title":"A new classification system for retrosternal based on a systematic review of its complications and management","volume":"6","author":"Huins\n              CT,","year":"2008","unstructured":"Huins\n              CT, \n            \n              Georgalas\n              C, \n            \n              Mehrzad\n              H, \n            \n              Tolley\n              NS. \n          \n          A new classification system for retrosternal based on a systematic review of its complications and management. 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Surg Today2004;34(9):732\u2013736"},{"issue":"1","key":"i0020-8868-99-4-419-b03","series-title":"Chest","first-page":"78","article-title":"Retrosternal goiter","volume":"108","author":"Madjar\n              S,","year":"1995","unstructured":"Madjar\n              S, \n            \n              Weissberg\n              D. \n          \n          Retrosternal goiter. Chest1995;108(1):78\u201382"},{"issue":"7","key":"i0020-8868-99-4-419-b04","series-title":"World J Surg","first-page":"1285","article-title":"Evidence-based surgical management of substernal goiter","volume":"32","author":"White\n              ML,","year":"2008","unstructured":"White\n              ML, \n            \n              Doherty\n              GM, \n            \n              Gauger\n              PG. \n          \n          Evidence-based surgical management of substernal goiter. 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Arch Surg2000;135(4):467\u2013472"},{"issue":"6","key":"i0020-8868-99-4-419-b11","series-title":"Acta Otorhinolaryngol Ital","first-page":"331","article-title":"Surgical approach to retrosternal goitre: do we still need sternotomy?","author":"Rugiu\n              MG,","year":"2009","unstructured":"Rugiu\n              MG, \n            \n              Piemonte\n              M. \n          \n          Surgical approach to retrosternal goitre: do we still need sternotomy?\n          Acta Otorhinolaryngol Ital\n          2009;(6):331\u2013338"},{"issue":"1","key":"i0020-8868-99-4-419-b12","series-title":"J Thorac Cardiovasc Surg","first-page":"39","article-title":"Surgical management of mediastinal goiters: when is a sternotomy required?","volume":"55","author":"De Perrot\n              M,","year":"2007","unstructured":"De Perrot\n              M, \n            \n              Fadel\n              E, \n            \n              Mercier\n              O, \n            \n              Farhamand\n              P, \n            \n              Fabre\n              D, \n            \n              Mussot\n              S\n            \n            et al\n          . 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Otolaryngol-Head Neck Surg2005;132(6):849\u2013851"},{"issue":"2","key":"i0020-8868-99-4-419-b20","series-title":"J Egypt Natl Canc Inst","first-page":"85","article-title":"Retrosternal goiter: the need for thoracic approach based on CT findings: surgeon's view","volume":"24","author":"Sakkary\n              MA,","year":"2012","unstructured":"Sakkary\n              MA, \n            \n              Abdelrahman\n              AM, \n            \n              Mostafa\n              AM, \n            \n              Abbas\n              AA, \n            \n              Zedan\n              MH. \n          \n          Retrosternal goiter: the need for thoracic approach based on CT findings: surgeon's view. J Egypt Natl Canc Inst2012;24(2):85\u201390"},{"issue":"1","key":"i0020-8868-99-4-419-b21","series-title":"Ann Otol Rhinol Laryngol","first-page":"15","article-title":"Radiologically predicting when a sternotomy may be required in the management of retrosternal goiters","volume":"122","author":"Riffat\n              F,","year":"2013","unstructured":"Riffat\n              F, \n            \n              Del Pero\n              MM, \n            \n              Fish\n              B, \n            \n              Jani\n              P. \n          \n          Radiologically predicting when a sternotomy may be required in the management of retrosternal goiters. Ann Otol Rhinol Laryngol2013;122(1):15\u201319"},{"issue":"6","key":"i0020-8868-99-4-419-b22","series-title":"Acta Chir Belg","first-page":"259","article-title":"Mediastinal goiters: when the transthoracic approach?","volume":"100","author":"Mussi\n              A,","year":"2000","unstructured":"Mussi\n              A, \n            \n              Ambrogi\n              MC, \n            \n              Iacconi\n              P, \n            \n              Spinelli\n              C, \n            \n              Miccoli\n              P, \n            \n              Angeletti\n              CA. \n          \n          Mediastinal goiters: when the transthoracic approach?\n          Acta Chir Belg\n          2000;100(6):259\u2013263"},{"issue":"4","key":"i0020-8868-99-4-419-b23","series-title":"Am Surg","first-page":"196","article-title":"Substernal and intrathoracic goiter: reconsideration of surgical approach","volume":"49","author":"Sand\n              ME,","year":"1983","unstructured":"Sand\n              ME, \n            \n              Laws\n              HL, \n            \n              McElvein\n              RB. \n          \n          Substernal and intrathoracic goiter: reconsideration of surgical approach. 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