Optimal position for a cervical collar incision: a prospective study.

BACKGROUND: The descriptions of the optimal method for placing a cervical collar incision for thyroidectomy or parathyroidectomy are varied. It has been our impression that a collar incision marked in the neutral upright neck, migrates superiorly relative to the sternal notch when the patient is placed in the supine position. The aim of this study was to investigate the validity of this impression and to assess whether this is influenced by patient factors and/or pathology.

METHODS: Fifty patients undergoing either thyroid or parathyroid surgery had a planned incision marked 1 finger-breadth (17 mm) above the sternal notch when sitting in the upright position. When placed in the supine position, with neck extended, the distance from the sternal notch to the marked incision was remeasured. Patient variables such as body mass index, height, weight and neck circumference were documented prospectively and data were recorded on operative details and tumour pathology.

RESULTS: The collar incision marked in the neutral upright neck, migrated on average 21 mm superiorly once the patient was placed supine with the neck extended (P=0. 0001 ).The extent of migration was independent of all patient factors, type of operation and thyroid or parathyroid pathology.

CONCLUSIONS: Migration of a proposed cervical collar incision does occur. An inappropriately placed incision may lead to excessive scarring if it is too low, or unusual prominence if it is too high. We believe a good position for marking such an incision is 1 fingerbreadth above the sternal notch with the patient in a neutral, upright position.