Thyroglossal duct cysts: presentation and management in children versus adults

OBJECTIVES: To determine if the clinical presentation of thyroglossal duct cysts (TGDC) varies between children and adults and whether this knowledge helps optimize the surgical management. METHODS: We retrospectively identified all patients with TGDC managed in our department between 1992 and 2002. We reviewed the patients' charts and recorded their gender, age at diagnosis, clinical presentation, radiologic imaging, surgical management, post-operative complications, and recurrence rate and compared the variables between the children and adults. RESULTS: Twenty-one children and 41 adults were treated for TGDC. Of the children, 57% were male and 43% were female, whereas 49% of the adults were male and 51% were female (P = 0.53). The average age was 6 +/- 5 years in children and 45 +/- 16 years in adults, which demonstrates a bimodal distribution. Forty-three percent of children and 42% of adults presented with an infected neck mass (P > 0.99). Among our patients, 96% of the adults and 100% of the children underwent a Sistrunk operation. Four children developed a wound infection that resolved with antibiotics. One adult developed a haematoma and another developed a wound seroma. There was one recurrence among adults and one among children, both of whom were treated with a second Sistrunk procedure. CONCLUSIONS: There appears to be a bimodal distribution for age at presentation of TGDC. Since the differential diagnosis among adults is broader, the opportunity for misdiagnosis is greater. However, once the correct diagnosis is made, the surgical management and post-operative outcome between adults and children is the same.     

“Extended” Sistrunk procedure in the treatment of recurrent thyroglossal duct cysts: A 10-year experience

Objective

We report a 10-year experience of children with recurrent thyroglossal duct cysts (TGDCs) who have been treated using the “extended” Sistrunk procedure.

Methods

We performed a retrospective review of TGDC surgery from 2004 to 2013. Sistrunk operation was the procedure of choice in all patients. Seven children had TGDC recurrence. All of them underwent “extended” Sistrunk procedure. Follow up ranged from 6 months to 8 years.

Results

There were no gender differences, all recurrences presented within 12 months follow-up in the same location of the primary cyst. Five out of 7 (71%) patients have been treated for preoperative and 2/7 (29%) for postoperative infection at the time of primary surgery. Pathological examination of the surgical specimens showed a single tract in 2 children (29%) and multiple tracts in 5 (71%). We did not observe postoperative complications or further recurrences.

Conclusion

Our experience suggest that recurrent TGDCs are equally common in both sexes, develop in the same location of the primary cyst and recur more commonly after perioperative infections. The “extended” Sistrunk procedure is highly effective and safe in treating recurrent TGDCs also if multiple duct tracts are detected.     

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.     

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.     

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.     

Outcome of thyroglossal duct cyst excision is independent of presenting age or symptomatology

BACKGROUND: Thyroglossal duct cysts (TGDCs) are the most common form of congenital neck cyst, accounting for up to 70% of such lesions. There has been no consensus on which factors predict outcome of thyroglossal duct cyst excision. The objective of the current study is to evaluate the relevance of symptomatology and age at presentation with outcome of TGDCs. METHODS: Retrospective review of patients with TGDC at a tertiary care children's hospital. Data collected included patient's age, gender, clinical presentation, presence or absence of preoperative infection, imaging modality, type of procedure performed, size and location of the lesion, postoperative infection, complications, and recurrence of disease. RESULTS: Twenty-nine patients were identified (59% female, 41% male). Age of presentation was bimodal and ranged from 18 months to 14 years. The most common presenting symptom was the presence of an asymptomatic midline neck mass (76%). A history of preoperative TGDC infection was present in 22% of patients /=5 years of age. Recurrence rate after the Sistrunk procedure was 3.4%. CONCLUSIONS: The finding of a midline neck mass is the most common presentation of TGDCs in toddlers, whereas infection is the most common presenting symptoms in school-aged children. The incidence of preoperative infection was 41% in our series, much higher than previously reported. Independent of presenting age and symptomatology, recurrence of TGDC remains low when the Sistrunk procedure is employed.     

Impact of age on surgical outcomes and failure rates in patients with thyroglossal duct cysts

PurposeThyroglossal duct cyst (TGDC) may appear in all age groups. The impact of age on surgical outcome has been reported with conflicting results. The aim of the study was to evaluate different risk factors for surgical success according to stratified age groups.MethodsA single center retrospective study. All patients who underwent a Sistrunk procedure between 2004 and 2018 were enrolled. Data included demographics, pre-operative presentation, intra\postoperative complications and surgical failures. Population groups were divided into adults (≥18 years), older children (OC, 3–18 years) and toddlers (<3 years).ResultsA total of 109 patients were included: 55 adults (50.5%), 36 OC (33%) and 18 toddlers (16.5%). The adult group demonstrated a significant lower rate of surgical failures when compared to the toddler (3.6%, vs. 38.9%, P < 0.001, respectively) and the OC group (3.6%, vs 16.7%, P = 0.032, respectively). A borderline significance was found when comparing surgical failure rates among toddlers and OC (38.9% vs.16.7%, P = 0.07, respectively). Post-operative complications were associated with surgical failures among toddlers (P = 0.045) and OC (P = 0.016), but not adults. Pre-operative infection and admission were significantly associated with failure in the OC group.ConclusionsSurgical failures following Sistrunk procedures and their associated risk factors vary between age groups. Familiarity with these rates and associations can contribute to better decision making in managing TGDC patients.     

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.     

Thyroglossal duct cysts and fistulae. Review of 30 consecutive operated patients

Thyroglossal duct cysts represent a very common pathology among the benign neck masses. An own review of 30 consecutive operated patients between 1994-2003 by our ENT Department is reported. There have been analysed different parameters like age, sex, personal antecedents, clinical symptoms, complementary explorations, surgical treatment, evolution and anatomopathologic result (AP). We think the Sistrunk procedure is the best operatory technique or strategy to perform to avoid recurrences.     

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。     

Characteristics of lingual thyroglossal duct cysts under flexible laryngoscopy and treatment approaches

ObjectivesLingual thyroglossal duct cysts (LTGDCs) are clinically rare and easily misdiagnosed as epiglottic cysts. Misdiagnosis leads to mistreatment; thus,simple diagnosis is important. This study aimed to investigate the characteristics of LTGDCs with flexible laryngoscopy and imaging, improve their diagnosis and explore surgical methods for patients undergoing an initial operation and patients with recurrence.MethodsIn total, 10 patients with LTGDCs were admitted from April 2014 to December 2020.By reviewing the diagnosis and treatment of the first typical case, the characteristics of LTGDC under flexible laryngoscopy were summarized. According to these characteristic manifestations, a clinical diagnosis of LTGDC was made correctly in the other 9 patients. All 10 patients underwent preoperative CT of the neck and sagittal reconstruction and thyroid ultrasound.ResultsOf the 10 patients, the first 2 patients had recurrent LTGDCs after several operations and underwent Sistrunk surgery. The remaining 8 patients were newly diagnosed and underwent endoscopic radical resection with low-temperature coblation; of these patients, 7 had no recurrence, and 1 underwent Sistrunk surgery after developing short-term recurrence. All patients were followed up for 5 months to 6 years after the last operation and were without recurrence.ConclusionLTGDCs are easily misdiagnosed as epiglottic cysts in the clinic. A correct clinical diagnosis can be made based on the characteristics according to flexible laryngoscopy. To determine the relationship between the cyst and hyoid bone, CT was performed. The surgical method was chosen based on the relationship between the cyst and hyoid bone and history of recurrence.     

Epidermal inclusion cyst versus thyroglossal duct cyst: sistrunk or not?

Epidermal inclusion cyst (EIC) is a recognized cause of an anterior neck mass in children. Controversy exists as to the proper surgical management of an anterior neck EIC: is simple excision adequate treatment, or is a Sistrunk procedure necessary? A retrospective review of the operative logs of the two senior authors (M.M.A., R.F.W.) from 1993 to the present revealed 16 children, ages 6 months to 9 years (mean, 4.5 years), with a diagnosis of anterior neck EIC. An accurate intraoperative diagnosis of an EIC in all cases allowed for a simple excision of the mass rather than a Sistrunk procedure. The final histologic diagnosis was EIC in all 16 patients. Follow-up of these 16 patients for a mean of 4.5 years revealed no recurrences or complications. When the diagnosis of EIC can be made confidently in the operating room, simple excision is an adequate surgical treatment.     

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.     

舌根部甲状舌管囊肿的诊断与治疗

目的 探讨发生于舌根部的非典型甲状舌管囊肿的临床表现、诊断和治疗方法.方法 回顾分析4例发生于舌根部的甲状舌管囊肿患者的临床资料,手术采用支撑喉镜下激光切除术和颈外径路Sistrunk术.结果 咽部异物感、咽部阻塞感是发生于舌根的甲状舌管囊肿的主要临床表现;颈部超声和CT检查是明确诊断的主要检查方法.支撑喉镜下激光手术无一例外均导致囊肿复发,3例复发1次,1例复发3次,颈外径路Sistrunk术将囊肿完整切除.结论 发生于舌根的甲状舌管囊肿应常规行颈部超声和CT检查,以明确诊断;治疗首选颈外径路Sistrunk术式.     

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     

Is drain placement necessary in pediatric patients who undergo the Sistrunk procedure?

Background

Thyroglossal duct cysts are usually managed with the Sistrunk procedure, which involves excision of the cervical cyst with the central portion of the hyoid bone, along with its tract. Surgical drains are commonly placed with this procedure, which necessitates postoperative hospital admission.

Objective

The aim of this study is to determine if surgical drain placement is necessary in pediatric patients who underwent the Sistrunk procedure.

Methods

The current study describes the outcomes of 30 consecutive children who underwent the Sistrunk procedure without drain placement. Complication rates are compared to an age-matched control group who had drains placed.

Results

No major complications, including hematomas were observed in the study group; outpatient surgery was safely observed in 20 patients. No significant difference in complication rates was observed between the study and control groups.

Conclusions

Routine drain placement in children who are undergoing the Sistrunk procedure may not be necessary. Subsequently, postoperative admission may be avoided.     

Cysts of the thyroglossal duct

Experiences with 53 consecutive patients undergoing surgical excision of thyroglossal duct cysts are reported. Four patients (7.5%) developed recurrent cysts after surgery. Analysis of cases revealed the following factors to contribute to an increased risk of recurrence: young age, skin involvement by the cyst, lobulation of the cyst, rupture of the cyst, and failure to follow the second principle advocated by Sistrunk.     

Clinical characteristics and surgical treatment outcomes of vallecular cysts in adults

Conclusion: It is suggested that transoral complete excision is the ideal treatment for adult vallecular cyst to avoid life-threatening acute airway obstruction and disease recurrence. Objective: The objective of this study was to review the clinical characteristics and surgical treatment outcomes of vallecular cysts in adults. Methods: A retrospective chart review was performed at Chonnam National University Hwasun Hospital from January 2009 to December 2014. Results: Nine patients (≥ 19-years-of-age) with a vallecular cyst were identified. Most of the patients had minimal or no symptoms at diagnosis. The presence of a vallecular cyst was confirmed in all of the patients by fiberoptic laryngoscopy. All of the cases with a vallecular cyst were treated by the transoral surgical procedure. Recurrence of the vallecular cyst was identified in two (22.2%) patients. One patient had been disease-free after the third operation through the transoral approach. Another patient who underwent marsupialization has been observed without surgery. There were no major complications resulting from surgical intervention.     

Preoperative sonography in presumed thyroglossal duct cysts

OBJECTIVE: To determine the utility of ultrasonography as a sole diagnostic study in the preoperative preparation of patients with presumed thyroglossal duct cysts. DESIGN: Retrospective chart review. SETTINGS: Children's Memorial Hospital, Chicago, Ill. PATIENTS: Forty-five pediatric patients with midline masses. MAIN OUTCOME MEASURE: Accuracy in the determination of a normally positioned thyroid gland excluding the presence of a solitary ectopic thyroid gland. RESULTS: A retrospective chart review was performed at our institution for the period February 1990 to January 1996. A total of 45 patients with midline masses were identified, 39 of whom had undergone preoperative ultrasonography as their sole diagnostic imaging study. In all 39 patients, both a cyst and a normal thyroid gland were identified. All 39 patients underwent the standard Sistrunk procedure. Thirty-seven patients had pathologically confirmed thyroglossal duct cysts. The remaining 2 had dermoid cysts. There were no cases of postoperative hypothyroidism. CONCLUSIONS: The incidence of ectopic thyroid in the diagnosis of thyroglossal duct cysts has been reported to be as high as 1% to 2%. In our surgical and clinical experience, the actual incidence of solitary ectopic thyroid tissue is substantially lower. Nevertheless, to prevent the inadvertent removal of the only functioning thyroid tissue, with resultant postoperative hypothyroidism and possible medicolegal consequences, we advocate the routine preoperative identification of normal thyroid gland. We recommend ultrasound as an accurate, cost-effective, noninvasive imaging modality in the preoperative evaluation of all patients with neck masses suspicious for thyroglossal duct cyst. Also, it does not require sedation.