Does neck extension elevate the thyroid gland cephalad to potentially improve access during thyroidectomy?

BACKGROUND

Patients undergoing thyroidectomy are positioned with the neck extended to facilitate exposure of the neck. Computed tomography (CT) scanning of the thyroid, without i.v. contrast, is often used preoperatively to investigate the extent of large goitres. Currently, patients are scanned in the neutral position rather than the surgical position of neck extension. The aim of the present study was to determine the degree, if any, of movement of the thyroid, as measured by CT, achieved by neck extension.

METHODS

A trial was designed using CT scanning of the neck. Fourteen patients were studied. Patients attended for the usual CT thyroid. In addition, they were then rescanned with their neck extended. The position of the inferior aspect of the gland in relation to the sternal notch was measured in both positions. The degree of neck extension was measured and correlated with the extent of thyroid gland movement. The data were analysed with the Wilcoxon signed rank test and Spearman correlation coefficients.

RESULTS

Results showed a median difference between the two positions of 5 mm (P = 0.0002).

CONCLUSION

The minimal cephalad movement of the thyroid achieved by neck extension, although statistically significant, is of doubtful clinical use, and overextension of the neck should be avoided because of its associated risks of pain, vomiting and spinal damage.