Key points: - The heterogeneity of retrosternal goiter size and location, nearby anatomical structures, and evolving surgical techniques means selecting the most appropriate individualised surgical approach remains challenging. - Although most retrosternal goiters can be removed transcervically, a small proportion of patients fulfill anatomical and radiological criteria for concurrent extracervical approaches based on decades of experience at the London Health Sciences Centre. - Anterior goiters above the level of the pericardium were resected using cervical thyroidectomy with either mediastinoscopic-assisted delivery or cervical thyroidectomy with video- assisted thyroidectomy (VATS) - Anterior goiters extending beyond the pericardium require median sternotomy to facilitate sufficient vascular control and exposure. - Posteriorly extending goiters can be managed using trans-thoracic approaches including lateral thoracotomy or VATS.

En-bloc clearance of malignant deep lobe parotid tumours involving the stylomandibular tunnel and parapharyngeal space is challenging in view of the limited surgical access and the critical structures that are located in close proximity The technique that we describe is a combined transmandibular-transmastoid approach that allows complete en-bloc resection of the deep parotid lobe and stylomandibular tunnel with a lateral temporal bone resection and a marginal mandibulectomy This approach provides good exposure of the critical structures and allows for a safe en-bloc resection and good oncological margins This clinical scenario is common in Australia, due to the high incidence of cutaneous squamous cell carcinoma involving the parotid gland, either through direct invasion or lymphatic spread In this article we explain step-by-step how to perform these resections to allow potential cure in patients with very locally advanced disease