A ten-year experience of thyroglossal duct cyst surgery in children

We discuss a 10-year experience of all the thyroglossal duct cysts (TGDC) removed at our institution, assessing whether management was appropriate and to compare our outcomes and success rate with current literature. We performed a retrospective review of TGDC surgery at our institution from 2000 to 2010. During the study period, 93 children were identified as having had a TGDC excision at an average age of 6.1 (1.1–15.3) years. Seventeen cases (18 %) were found to have not had their hyoid bone removed and of these 10 (59 %) were proven on histology to be non-TGDC. A total of 19 cases were confirmed TGDC on histology but received a non-Sistrunk’s procedure and 12 (63 %) of those recurred requiring a more definitive procedure (i.e. Sistrunks). Of the 76 (82 %) that did have their hyoid bone removed 13 (17 %) suffered complications of which 3 were recurrences (3.9 %), which is comparable to the literature (3–5 %). Of the complications that occurred 11 out of 13 (85 %) were infected cases at or around the time of procedure. Our experience, being the largest described in the United Kingdom supports the use of Sistrunk’s procedure with recurrence rates comparable to that within the literature.     

复发性甲状舌管囊肿(瘘管)的原因探讨和预防措施

目的：探讨甲状舌管囊肿（瘘管）术后复发的原因和提高手术疗效的措施。方法：对３２例甲状舌管囊肿（瘘管）病例（含８例术后复发者）,术前感染病例先行抗炎后再手术,准确判定甲状舌管囊肿与舌骨的关系,处理舌骨;术中衔注美蓝液入囊管内示踪,行Ｓｉｓｔｒｕｋ术式,分离小分支,以手术显微下失去示踪小支,手指接触诊疑为残存病灶处,行环形缝扎或电凝,射频等处理。结果：３２例均获成功,随访１年以上未见复发。结论：对甲状     

Endoscope-assisted intra-oral resection of the external thyroglossal duct cyst

Objective

Surgical removal of a thyroglossal duct cyst (TGDC) and its tract is usually accomplished through an external neck incision, including the removal of the middle part of hyoid bone and a block of tissues extending to the foramen cecum. However, this procedure inevitably results in neck scarring. We implemented a modified approach to TGDC removal in a 28-year-old woman through the floor of the mouth using an endoscope system.

Case report

Here, we describe the detailed procedure of the endoscope-assisted intra-oral resection for TGDC. The total operative time was 130 minutes. The patient complained of swelling and pain in the floor of the mouth for 2 days, but did not require any intervention. Follow-up imaging studies confirmed no recurrence (18 months) without any sequelae, and the patient was satisfied with her surgical outcome.

Conclusion

The intra-oral approach through the floor of the mouth is a technically feasible alternative surgical option that allows for complete removal of a TGDC without the neck scar.     

Sistrunk revisited: a 10-year review of revision thyroglossal duct surgery at Toronto's Hospital for Sick Children

The definitive surgical management of thyroglossal duct cysts (TGDC) was elucidated by Sistrunk in 1920. However, the procedure is often poorly performed. We reviewed the charts of 143 patients managed for TGDC at the Hospital for Sick Children. Toronto, between 1978-1988. These patients underwent 214 surgical procedures at HSC and elsewhere for cure. One hundred and five patients needed only one procedure. Thirty-eight patients had recurrent disease. These needed 109 procedures for cure. Inadequate surgery was the direct cause of recurrence. Areas of surgical failure included misdiagnosis, inadequate hyoid bone resection and persistent infra or suprahyoid tract remnants. Representative case samples are outlined with clinical, surgical and pathologic correlation. We recommend performing the complete, classic Sistrunk procedure for all cases of TGDC.     

Recurrent thyroglossal duct cysts: a 23-year experience and a new method for management

OBJECTIVES: We present an experience in the management of primary and recurrent thyroglossal duct cysts (TGDCs) and describe a novel method for recurrent TGDC removal. METHODS: We performed a retrospective review of TGDC surgery at Children's Hospital in Seattle from 1980 to 2003. The surgical techniques for primary and recurrent TGDCs and the factors associated with TGDC recurrence were evaluated and analyzed. RESULTS: During the study period, 231 patients underwent 296 TGDC surgeries. Thirty-four of the 231 patients (15%) underwent a total of 88 procedures for recurrent TGDCs. Successful procedures used for secondary TGDC management included central neck dissection with directed base of tongue (BOT) excision in 6 of 9 patients (67%), secondary Sistrunk operation with limited BOT resection in 12 of 27 patients (44%), revision Sistrunk operation with BOT dissection in 7 of 11 patients (64%), and suture-guided transhyoid pharyngotomy in 8 of 8 patients (100%). Ten of the 231 patients (4%) had initial TGDC incision and drainage and then underwent a total of 21 procedures, excluding the incision and drainage. The factors associated with TGDC recurrence were inaccurate initial diagnosis (17 of 34 or 50%), infection (5 of 34 or 15%), unusual TGDC presentation (5 of 34 or 15%), and lack of BOT musculature removal (7 of 34 or 20%). The level of surgeon training affected the surgical outcome. CONCLUSIONS: Successful TGDC treatment requires consideration of factors associated with recurrence. Recurrent TGDCs can be treated by several methods, including suture-guided transhyoid pharyngotomy.     

Supra and infra hyoid midline cervical cysts or hyoglossal abnormalies: a propos of 45 cases

OBJECTIVES: To specify the embryologic origin of the sus and sub hyoidal midline cervical cysts after studying a series of 45 patients. MATERIALS AND METHODS: 45 files were analyzed retrospectively between 1983 and 2004. RESULTS: The population concerns 21 women and 24 men with ages going from 3 to 71 years (8 children of less than 10 years). The location of the lesions is supra-hyoidal (12), sub-hyoidal (27), pre-hyoidal (2), basi-lingual (4), a cyst was a fortuitous discovery at the time of a laryngeal surgery. All these patients were operated by external way with resection of the hyoid bone in 40 cases. The histological examination made it possible to differenciate 18 cysts associated with thyroid vesicules, 24 granulomatous cysts, 1 mucoid cyst, 1 epidermidal cyst and 1 ectopic thyroid. Four observations are more precisely detailed. CONCLUSION: In spite of the strong proportion of cysts of the thyroglossal tract there is different types of cysts evoking a median dysraphy. Rather than speaking about thyroglossal anomalies, the authors propose to call them hyo-glossal anomalies because these lesions are always involving the hyoid bone. The situation of thyroid gland must always be located before surgery, clinically, by echography or scintigraphy. The surgical technique must remove the hyoid bone in monobloc while going up until the contact of the base of the tongue.     

The feasibility of pediatric TORS for lingual thyroglossal duct cyst

A six-year-old boy who presented with symptoms of obstructive sleep apnea was found to have a midline tongue mass suspicious for lingual thyroglossal duct cyst (TGDC). Surgery was scheduled after workup confirmed the presence of functional, orthotopic thyroid tissue. The surgical robot was used to excise the mass endoscopically without removing any hyoid. He was extubated at the conclusion of the case. The child tolerated a soft diet and was discharged after an uneventful overnight stay in the ICU. Pathology confirmed TGDC. There have been no reported issues in eleven months of follow-up. Our report adds to the scarce literature on performing such a surgery in a child and demonstrates that with the correct circumstances, prompt extubation, discharge, and prolonged remission are possible.     

Simple laryngeal suspension procedure by suturing the digastric muscle to the periosteum of the mandible in neck dissection for tongue cancer

Purpose

In this article, a simple, new laryngeal suspension procedure is described. The effect of hyoid bone suspension by suturing the digastric muscle to the periosteum of the mandible is analyzed.

Histological characterization of the thyroglossal tract: implications for surgical management

OBJECTIVES: In the current report, we characterized the relationship between the central hyoid bone and the thyroglossal tract and determined the prevalence of ectopic thyroid follicles in the adjacent soft tissues. STUDY DESIGN: Retrospective pathological analysis. METHODS: The resected specimens from 104 patients who underwent a modified Sistrunk procedure with wide-field dissection were retrospectively analyzed. Under light microscopy, serial sections were examined to determine whether the thyroglossal tract passed anterior to, posterior to, or within the hyoid bone. Specimens were also examined for the presence of thyroid follicles in the periductal and pericystic soft tissues. RESULTS: In 50 cases (48%), the tract position in relation to the hyoid bone could not be identified secondary to extensive arborization, marked inflammation, specimen fragmentation or a combination of these. Thyroid follicles were observed in 9 (18%) of these specimens. In the remaining 54 cases (52%) the tract was located anterior to the central arch of the hyoid bone in 39 (72%) and posterior to it in 15 (28%). Thyroid tissue was observed in 46% of specimens (P =.004), regardless of whether the tract was anterior or posterior. CONCLUSIONS: These results demonstrate that tract position often cannot be defined, but when a portion is dominant, it is likely to be anterior to the hyoid bone. Ectopic thyroid tissue can be found in almost 50% of specimens when the tract position is identifiable. With appropriate surgical management, a recurrence rate of less than 4% can be expected, despite the presence of ductule multiplicity, marked inflammation, tract position posterior to the hyoid bone, and ectopic thyroid follicles.     

颈外径路Sistrunk手术治疗成人复发性舌甲状舌管囊肿的临床分析

目的 探讨成人复发性舌甲状舌管囊肿（LTGDC）的临床特点、误诊原因及手术治疗。方法 回顾性分析2018年1月—2021年3月收治的6例反复复发的成年LTGDC患者,术前行甲状腺B超提示甲状腺位置并排除异位甲状腺,颈部CT检查明确肿物大小、部位及与舌骨的关系,喉咽部MRI明确肿物性质。手术均采用颈外径路Sistrunk手术。结果 6例患者曾误诊为会厌囊肿4例,舌根囊肿2例,均已行囊肿切除术,复发时间3周至1年。所有患者行颈外径路Sistrunk手术完整切除甲状舌管囊肿及瘘管,术后病理确诊为甲状舌管囊肿。术后随访1年以上无复发。结论 复发性舌根部或会厌间隙的囊性肿物应考虑LTGDC的可能性。所有患者术前均应行喉镜检查和颈部影像学检查以了解囊肿的形态、位置及其和舌骨的关系来选择手术方式。对于成人复发性LTGDC,Sistrunk手术可彻底切除囊肿减少复发。     

内镜在婴幼儿舌根囊肿手术中的临床应用分析

目的 探讨内镜在治疗耍幼儿舌根囊肿手术中的临床应用价值与疗效.方法 回顾性分析65例婴幼儿舌根囊肿患者临床资料,内镜下支撑喉镜下行舌根囊肿等离子消融术39例,肉眼直视下支撑喉镜下行舌根囊肿等离子消融术26例,分析内镜下与肉眼直视下手术治疗婴幼儿舌根囊肿在术创处理、术后拔管时间及复发等情况的差异性.结果 内镜组转ICU延...     

Lingual thyroglossal duct cysts--a review

Objectives

Lingual thyroglossal duct cysts (TGDC) are rare and liable to be missed in a cursory clinical examination. This study aimed to report the details of lingual TGDC from the authors’ series and review existing literature on the entity.

Methods

A 12 year retrospective survey of all cases of thyroglossal duct anomalies managed at a tertiary teaching hospital was conducted to identify those with lingual TGDC. Their clinical presentation, investigations, diagnosis and management were analysed. Case series from anecdotal published English literature were critically reviewed with particular regard to diagnosis and management.

Results

Of 78 cases of thyroglossal duct anomalies, 3 were lingual TGDC. All were females. One neonate presented with feeding difficulty and was clinically misdiagnosed as a ranula. The two older children presented with a cyst at the foramen caecum. The varied imaging and diagnostic dilemma are presented. The older children had cysts abutting the hyoid and were managed with transoral excision and a Sistrunk procedure; the neonate was managed with transoral excision only. This report also reviews the sparse literature and discusses specific issues in their treatment. The differential diagnoses encompass a wide array of developmental and neoplastic entities. Specific anatomic imaging with USG/CT/MRI and functional evaluation with radionuclide thyroid scan are essential investigative modalities. Besides a classical Sistrunk procedure and simple transoral excision, newer less invasive treatment options including marsupialisation and alcohol ablation have been reported.

Conclusions

In conclusion, the diagnosis and management of lingual TGDC needs to be individualised depending on their presentation and anatomic location. The Sistrunk's procedure is ideal for those in close proximity to the hyoid; however complete cyst excision would suffice in the rest.     

声门上水平喉部分切除术中舌骨去留对误咽的影响

目的 探讨声门上水平喉部分切除术中保留与切除舌骨对误咽的影响。方法 回顾分析1998年1月至2011年10月菏泽市立医院耳鼻咽喉科收治的39例声门上型喉癌行声门上水平喉部分切除术的临床资料, 将其中年龄在56~67岁且无脑血管病、神经系统疾病及呼吸系统疾病的声门上型喉癌(T₁~T₃)行声门上水平喉部分切除术的39例患者作为观察对象, 其中19例未切除舌骨, 20例切除舌骨。结果 病例切缘均为阴性, 发声接近正常, 拔管率为100%;保留舌骨的19例中, 2例(10.5%)有轻度误咽, 10例(52.6%)中度误咽, 7例(36.8%)重度误咽, 误咽恢复时间为(31±3)d;2例并发吸入性肺炎。切除舌骨的20例中, 轻度误咽11例(55.0%), 中度误咽9例(45.0%), 无重度误咽, 误咽恢复时间为(15±2)d;无吸入性肺炎发生。结论 声门上水平喉部分切除术中切除舌骨、充分利用舌根对声门的遮盖作用, 可有效减轻术后误咽程度, 缩短误咽恢复时间, 防止或减少吸入性肺炎的发生。     

Thyroglossal duct cyst: personal experience and literature review

The thyroglossal duct cyst [TDC, or thyroglossal tract remnant (TTR)] is a well recognized developmental abnormality which arises in some 7% of the population. As a consequence, it represents the most common type of developmental cyst encountered in the neck region. It typically presents as a mobile, painless mass in the anterior midline of the neck, usually in close proximity to the hyoid bone. Less often, TDCs may present with signs and symptoms of secondary infection, or with evidence of a fistula. While TDCs are most often diagnosed in the pediatric age group, a substantial minority of patients with TDCs are over 20 years of age at the time of diagnosis. The standard surgical approach to TDC, encompassing removal of the mid-portion of the hyoid bone in continuity with the TDC and excision of a core of tissue between the hyoid bone and the foramen cecum, dates back to the late 19th and early 20th centuries and is often referred to as Sistrunk's operation. Malignancy is rarely encountered in TDCs; when such rare tumors do develop (in the order of 1% or so of patients with TDCs), they usually take the form of either papillary carcinoma of thyroid origin, or squamous carcinoma.     

Congenital cysts and fistulas of the neck

On the base of literature and their own 123 patients the authors present the frequency, diagnostics and treatment of congenital neck fistulas and cysts. We had 9 congenital fistulas: 6 median and 3 lateral. We treated 114 patients with neck cysts.: 29 median and 85 lateral, from which 50 were at the right side. The disease mainly manifested in 10-19 year-old patients--25 cases and in 30-39 year-old patients--21 cases. We divided the lateral neck cysts according to Bailey's--the most frequent of which were of III type--44.7%, II type--32.94%, IV type 16.58% and I type 5.88%. All patients were radically operated on-that is they had totally enucleated fistula or cyst. In the case of median fistulas or cysts we didn't extirpate the body of the hyoid bone but in the case of duct going to caecal foramen of the tongue, we elevated the hyoid bone and with Storz lupe we prepared the duct to the root of the tongue. We didn't have any recurrence resulting from this kind of treatment. We had a recurrence in one patient (0.81%) with median cyst of the neck which was localised in the lower part of the neck and was connected with thyroid. We reoperated this patient and we had a complete recovery.     

Endoscopic management of intralingual thyroglossal duct cysts: Case series and systematic review

ObjectiveTo discuss our institutional experience with endoscopic management of intralingual thyroglossal duct cyst (TGDC) and review cases in the published literature in a systematic review.MethodsPediatric patients with intralingual TGDC treated with endoscopic surgery at our institution from 2009-2019 were identified. Metrics from our case series were then compared to those in the literature in a systematic review to assess pooled outcomes of endoscopic or transoral management. Patient demographics, age of presentation, presenting symptomatology, size of cyst on imaging, type of surgery, and post-operative outcomes were assessed.ResultsWe identified 5 institutional cases of intralingual TGDC and 48 cases of intralingual TGDC described in the literature. The average age of presentation was 20.36 months. 69.8% (N=37) of patients presented with at least one respiratory symptom, 22.6% (N=12) presented with dysphagia, 9.4% (N=5) presented with an identified mass in the oropharynx, and 15.1% (N=8) had the cyst discovered as an incidental finding. Three patients required revision surgeries due to prior incomplete TGDC excisions and one patient experienced a recurrence >6 months after primary excision requiring a second procedure. Our data pooled with published case series in systematic review confirms that endoscopic or transoral management are excellent options for definitive management of intralingual TGDC.ConclusionsIntralingual TDGC is a potentially life-threatening variant of TGDC. Our results pooled with published series in a systematic review suggest that endoscopic or transoral management of intralingual TGDC are excellent minimally invasive treatments with a low risk of recurrence. Postoperative surveillance up to one year is recommended.     

Thyroglossal duct remnants

Thyroglossal duct remnants presenting as a lump in the neck are usually called thyroglossal cysts. Meticulous dissection of the cyst and duct, along with the body of the hyoid bone (Sistrunk's operation) is necessary to avoid recurrence. The authors have reviewed the histology of 61 consecutive specimens diagnosed preoperatively as thyroglossal cysts and have found that a true cyst exists in only 46 per cent of cases.     

Doxycycline: A sclerosant agent to treat a case of recurrent thyroglossal duct cyst

Thyroglossal duct cyst (TGDC) is one of the most common congenital anterior midline neck masses in children. Sistrunk operation is considered as the cornerstone in TGDC removal. Nevertheless, 5% to 7 % of patients have been reported to show a recurrence even after adequate resection. This necessitates at times multiple resections with potential complications. One interesting emerging technique is sclerotherapy of TGDC remnants post resection. We present here a case of a child who had a successfully treated recurrent TGDC using sclerotherapy with doxycycline.     

Laryngeal sensation and pharyngeal delay time after (chemo)radiotherapy

The objective of the study was to evaluate the association between changes in laryngeal sensation and initiation of swallowing reflex or swallowing function before and after (chemo)radiotherapy. A prospective study was conducted in a tertiary referral university hospital. Thirteen patients who received (chemo)radiotherapy for treatment of laryngeal or hypopharyngeal cancer were included. Laryngeal sensation was evaluated at the tip of the epiglottis before and 1, 3 months, and 1 year after (chemo)radiotherapy. Videofluoroscopy was performed at the same time. Quantitative determinations included changes in laryngeal sensation, computed analysis of pharyngeal delay time, the distance and velocity of hyoid bone movement during the phase of hyoid excursion, and pharyngeal residue rate (the proportion of the bolus that was left as residue in the pharynx at the first swallow). Laryngeal sensation significantly deteriorated 1 month after (chemo)radiotherapy, but there was a tendency to return to pretreatment levels 1 year after treatment. Neither pharyngeal delay time nor displacement of the hyoid bone changed significantly before and after (chemo)radiotherapy. In addition, there was no significant difference in the mean velocity of hyoid bone movement and the amount of stasis in the pharynx at the first swallow before and after (chemo)radiotherapy. After (chemo)radiotherapy, laryngeal sensation deteriorated. But, in this study, videofluoroscopy showed that swallowing reflex and function were maintained.     

Thyroglossal duct cyst: a comparison between children and adults

PURPOSE: The purpose of the study was to evaluate the differences in the clinical characteristics of thyroglossal duct cysts (TGDC) between children and adults and to find a method for optimizing management of TGDC. MATERIALS AND METHODS: This study consisted of a retrospective chart review of patients with a diagnosis of TGDC from 1997 to 2002. All records were reviewed for age and sex, season of first visit, diagnostic methods, sizes and locations of cysts, surgical management, and recurrences. Differences between children and adults were analyzed. RESULTS: A total of 84 patients (32 children, 52 adults) were recruited. There were no significant differences in sex in either group. Compared with children, more adult patients had left-sided and infrahyoid cyst locations. The cyst sizes were significantly larger in adults. In this review, 90.4% of adults and 75% of children underwent a Sistrunk operation, whereas the others underwent cyst excision. There was a total of 5 recurrences, 2 in children and 3 in adults. CONCLUSION: Although the recurrence rates between children and adults and between different surgical managements were not significantly different, a Sistrunk procedure is recommended as the main operation of choice, especially in adults in whom a more extended tract resection should be performed.