Introduction: Haller first described substernal goiter in 1749. Authors report different definitions, but the most commonly used defines substernal goiter as a goiter that does not sit in the neck in the operating position and has a lower extension to more than two fingers breadth under the manubrium. The aim of our work is to highlight the perioperative anesthetic and surgical difficulties within substernal goiters' care.
Materials and methods: This is a retrospective study conducted in both anesthesiology and thoracic surgery departments in Moulay Ismail hospital in Meknes over a period of three years from January 2013 to December 2015. This study has been based on the medical records of all patients operated for substernal goiter. The data investigated were: demographic characteristics, medical and surgical history, Mallampati and intubation difficulties, surgical approach, and finally intraoperative and postoperative complications.
Results: The average age of our patients was 61.5 years with extremes ranging from 34 to 83 years old. The most affected age group was between 50 and 70 years old, 9 out of 56 cases. The sex ratio was 1.5, 10 women and 6 men. The approach was anterior cervicotomy, with total thyroidectomy, in almost all patients. A thoracotomy was decided from the outset for a single patient with goiter missed in endothoracic after thyroid surgery. The evolution was favorable in 16 patients of our series. Redon drains were removed 48 to 72 hours after surgery and the average hospital stay was five days.
Conclusion: The substernal goiter care is easier if a full preoperative examination is made, allowing the anticipation of eventual anesthetic and surgical difficulties.
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