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Fernández Figueras MT, Alzoghby-Abi Chaker J, Fernandez-Parrado M, García Herrera A, Garrido M, Idoate Gastearena MÁ, Llamas-Velasco M, Monteagudo C, Onrubia J, Pérez Muñoz N, Ríos-Martín JJ, Rodríguez Peralto JL, Rozas Muñoz E, Sanmartín O, Santos-Briz Á, Saus C, Suárez Peñaranda JM, Velasco Benito V, Beato Merino MJ, Fernandez-Flores Á. [Main Types of Cysts in Dermatopathology: Part 2]. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2024; 57:97-110. [PMID: 38599743 DOI: 10.1016/j.patol.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/23/2023] [Indexed: 04/12/2024]
Abstract
This is the second article in a two-part series published in this journal, in which we examine the histopathological characteristics, as well as the differential diagnosis, of the main entities that present as cystic and pseudocystic structures in cutaneous biopsy. In this second article, we address ciliated cutaneous cysts, branchial cysts, Bartholin's cysts, omphalomesenteric cysts, thymic cysts, thyroglossal duct cysts, synovial cysts, and median raphe cysts, as well as mucocele, ganglion, and auricular and digital myxoid pseudocysts.
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Affiliation(s)
- María Teresa Fernández Figueras
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Grupo QuironSant Cugat del Vallès, Barcelona, España
| | | | | | | | - María Garrido
- Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - Mar Llamas-Velasco
- Servicio de Dermatología, Hospital Universitario de la Princesa, Madrid, España
| | - Carlos Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Valencia, España
| | - José Onrubia
- Servicio de Anatomía Patológica, Hospital Universitario San Juan de Alicante, Alicante, España
| | - Noelia Pérez Muñoz
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Grupo QuironSant Cugat del Vallès, Barcelona, España
| | - Juan José Ríos-Martín
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | | | - Onofre Sanmartín
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - Ángel Santos-Briz
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - Carles Saus
- Servicio de Anatomía Patológica, Hospital Universitario Son Espases, Palma de Mallorca, España
| | | | - Verónica Velasco Benito
- Servicio de Anatomía Patológica, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | | | - Ángel Fernandez-Flores
- Servicio de Anatomía Patológica, Hospital Universitario El Bierzo, Ponferrada, León, España.
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Ahn D, Kwak JH, Lee GJ, Sohn JH. Ultrasound-guided ethanol ablation versus the Sistrunk operation as a primary treatment for thyroglossal duct cysts. Ultrasonography 2024; 43:25-34. [PMID: 38087396 PMCID: PMC10766887 DOI: 10.14366/usg.23128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/19/2023] [Accepted: 09/02/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE This study compared ethanol ablation (EA) with the Sistrunk operation (SO) with regard to feasibility, treatment efficacy, and cost-effectiveness. The goal was to evaluate whether EA could replace SO as a primary treatment modality for thyroglossal duct cysts (TGDCs). METHODS This retrospective case-control study included patients with TGDCs who were treated with either EA or SO between 2016 and 2022. The primary outcome variables evaluated were treatment efficacy (as measured by the volume reduction rate [VRR] and treatment success rate), complications, and cost-effectiveness. RESULTS A total of 72 patients were enrolled, with 33 in the EA group and 39 in the SO group. The procedure or operation times for the EA and SO groups were 9 and 82 minutes, respectively (P<0.001). At the final follow-up appointment, the VRR was 94.1% for the EA group and 100.0% for the SO group (P<0.001). Treatment success was achieved for 32 patients (97.0%) in the EA group and for all 39 patients (100.0%) in the SO group (P=0.458). The overall complication rates were 0.0% and 17.9% in the EA and SO groups, respectively (P=0.013). The total costs, including all treatment procedures and follow-up ultrasound examinations, were $485 and $1,081.7 for the EA and SO groups, respectively (P<0.001). CONCLUSION EA demonstrates superiority over SO in terms of feasibility, safety, and costeffectiveness, while maintaining comparable treatment efficacy. Despite the need for multiple treatment sessions in approximately one-quarter of patients, EA can serve as a primary treatment modality for selected patients with TGDCs, supplanting SO.
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Affiliation(s)
- Dongbin Ahn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ji Hye Kwak
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Gil Joon Lee
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Ho Sohn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Wynings EM, Wang CS, Parsa S, Johnson RF, Liu CC. Risk-adjusted analysis of perioperative outcomes after the Sistrunk procedure. Laryngoscope Investig Otolaryngol 2023; 8:1571-1578. [PMID: 38130263 PMCID: PMC10731482 DOI: 10.1002/lio2.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/22/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives Thyroglossal duct cyst (TGDC) is the most common pediatric congenital neck mass. The Sistrunk procedure is the standard method of excision and is associated with low rates of recurrence. This study aimed to review our institution's outcomes following the Sistrunk procedure, specifically the rates of wound complications and cyst recurrence. Methods This was a retrospective case series of pediatric patients undergoing the Sistrunk procedure from June 2009 to April 2021. Results A total of 273 patients were included. Of these, 139 (53%) patients were male and 181 (66%) were white. The average age at the time of surgery was 7.1 years. The overall cyst recurrence rate was 11%. The most common wound complications were seroma (14%) and surgical site infections (SSIs) (12%). Wound complications were associated with prior history of cyst infection (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.07-3.60, z-test 2.2, p = .03). Pediatric surgery was associated with fewer wound complications (OR 0.18; 95% CI 0.05-0.6, z-test -2.78, p = .005). However, pediatric surgery operated on fewer patients with a history of cyst infection (36% vs. 55%, p = .012). Drain placement and postoperative antibiotics did not affect rates of wound complications. Conclusions Prior cyst infection is associated with increased rates of postoperative wound complications. Postoperative antibiotics and drain placement did not significantly affect complication rates. Level of Evidence 4.
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Affiliation(s)
- Erin M. Wynings
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Cynthia S. Wang
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Shyon Parsa
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Romaine F. Johnson
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Division of Pediatric OtolaryngologyChildren's Medical Center DallasDallasTexasUSA
| | - Christopher C. Liu
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Division of Pediatric OtolaryngologyChildren's Medical Center DallasDallasTexasUSA
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Li B, Wang Y, Fu Y, Liu D, She C. Diagnosis and Treatment of Double Thyroglossal Duct Cyst. J Craniofac Surg 2023; 34:e763-e767. [PMID: 37594049 PMCID: PMC10597424 DOI: 10.1097/scs.0000000000009633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/08/2023] [Indexed: 08/19/2023] Open
Abstract
This retrospective study aimed to investigate clinical diagnostic and management characteristics of double thyroglossal duct cyst (TDC) cases. Seventy-eight patients diagnosed with TDCs who were admitted to the inpatient ward of the Department of Otolaryngology, Dalian Central Municipal Hospital from June 2008 to October 2021 were included in the study. Ultimately, 67 of these patients were diagnosed with single TDCs and 11 patients with double TDCs. Each patient underwent computed tomography and color doppler ultrasound imaging of their neck masses, thyroid color doppler ultrasound imaging, and surgical cyst removal through the classic Sistrunk procedure. All surgically excised specimens were sent to the pathology lab for examination and were confirmed to contain TDCs. Two of the 67 patients with single TDCs experienced postoperative complications related to infections within the operative area, whereas no patients with double TDCs experienced postoperative infection, excessive bleeding, or other surgical complications. All cases were followed up for 1 to 3 years after surgery with no cyst recurrence observed. Double TDCs may present on physical examination as unilateral neck masses that interfere with tongue extension and movement and swallowing that can be identified using imaging methods. Correct clinical diagnosis and complete surgical removal of cysts are key measures for ensuring successful treatment outcomes for patients with TDCs.
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Affiliation(s)
- Bo Li
- Department of Otorhinolaryngology Head and Neck Surgery, Dalian Municipal Central Hospital
- Dalian Medical University, Dalian, China
| | - Yu Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Dalian Municipal Central Hospital
- Dalian Medical University, Dalian, China
| | - Yangyang Fu
- Department of Otorhinolaryngology Head and Neck Surgery, Dalian Municipal Central Hospital
| | - Delong Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Dalian Municipal Central Hospital
| | - Cuiping She
- Department of Otorhinolaryngology Head and Neck Surgery, Dalian Municipal Central Hospital
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Eeftinck Schattenkerk LD, Lekkerkerker I, Hoekstra C, van Heurn LWE, Derikx JPM, Deurloo E. Diagnostic accuracy of ultrasonography to distinguish thyroglossal duct cysts from dermoid cysts in children with a midline neck swelling. Am J Otolaryngol 2023; 44:103861. [PMID: 37454553 DOI: 10.1016/j.amjoto.2023.103861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/19/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Midline neck swellings are very common in children and mostly caused by thyroglossal duct cysts (TGDCs) or dermoid cysts (DCs). Since DCs can undergo simple excision, whilst TGDCs demand more thorough resection via Sistrunk procedure, it is important to differentiate between both pre-operatively. Previous studies have suggested an ultrasound-score (SIST) based on presence of septae, wall irregularity and solid components could do so. This study aims to evaluate the diagnostic accuracy of this score. METHODS All patients (≤18 years) undergoing surgery between 2006 and 2018 for a midline neck mass at our tertiary centre with a histopathological diagnosis of TGDC or DC were retrospectively included. The pre-operative ultrasound was evaluated by an experienced radiologist and the SIST as well as location, tract, echogenicity, margin and multilocularity were scored. RESULTS We included 97 children, of whom 67 (69 %) with TGDCs. The SIST showed a sensitivity of 37 %, specificity of 97 %, a positive predictive value of 96 % and a negative predictive value of 35 % for the SIST-score in detecting TGDCs, which resulted in an AUC of 0.67. In addition, internal echogenicity (P < 0.01) and margin definition (P < 0.01) were significantly associated to TGDC diagnosis whilst location and multilocularity were deemed insignificant following Bonferroni correction. CONCLUSION We conclude that the SIST-score seems very capable to rule in TGDC. However, the SIST-score is far from making a clear distinction between DC and TGDCs preoperatively. The addition of other ultrasound variables, such as margin definition and echogenicity, might increase the diagnostic accuracy and demands further research.
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Affiliation(s)
- Laurens D Eeftinck Schattenkerk
- Emma Children's Hospital, Amsterdam UMC, Department of Paediatric Surgery, the Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, the Netherlands.
| | - Iris Lekkerkerker
- Emma Children's Hospital, Amsterdam UMC, Department of Paediatric Surgery, the Netherlands
| | - Carlijn Hoekstra
- Amsterdam UMC, Department of Otorhinolaryngology, the Netherlands
| | - L W Ernest van Heurn
- Emma Children's Hospital, Amsterdam UMC, Department of Paediatric Surgery, the Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Joep P M Derikx
- Emma Children's Hospital, Amsterdam UMC, Department of Paediatric Surgery, the Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Eline Deurloo
- Amsterdam UMC, Department of Radiology, the Netherlands
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Ahn D. Ultrasound-Guided Ethanol Ablation for Thyroglossal Duct Cyst: A Review of Technical Issues and Potential as a New Standard Treatment. J Clin Med 2023; 12:5445. [PMID: 37685512 PMCID: PMC10487699 DOI: 10.3390/jcm12175445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
The thyroglossal duct cyst (TGDC) is the most common congenital neck mass, accounting for 70-75% of all congenital neck masses. Although the Sistrunk operation has been used as a standard of treatment, it is accompanied by a considerable surgical burden, including the need for general anesthesia, a visible surgical scar on the neck surface, and postoperative complications. Ultrasound-guided ethanol ablation (US-EA) is a minimally invasive and office-based technique that is widely used as a non-surgical treatment for several benign cystic lesions, particularly benign thyroid cysts. Recently, US-EA has also been gaining popularity as a good alternative for TGDC treatment, which is associated with high feasibility, a high safety profile, and favorable treatment outcomes. To our best knowledge, seven studies on the use of EA as a primary treatment option for TGDC have been published since 2011. Although these studies have reported promising results, there is a lack of consensus on several issues regarding the application of EA for TGDC, particularly its detailed techniques and role as a primary treatment. This article aims to provide a comprehensive review of EA for TGDC, addressing technical issues and its possible role as a new standard of treatment for TGDC.
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Affiliation(s)
- Dongbin Ahn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Republic of Korea
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Mettias B, Cole S, Valsamakis T. Preoperative investigations in thyroglossal duct cyst surgery: a 9-year experience and proposed practice guide. Ann R Coll Surg Engl 2023; 105:554-560. [PMID: 37390846 DOI: 10.1308/rcsann.2022.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION Thyroglossal duct cysts (TGDC) are the commonest midline developmental cyst and have a bimodal age distribution. They usually develop in an infrahyoid position. A National survey of TGDC practice among otolaryngologists in 2012 recommended preoperative investigation with ultrasound, with or without blood tests. METHODS Retrospective analysis of preoperative investigation for clinically diagnosed TGDC surgeries between 2012 and 2020 in a single tertiary centre was undertaken. This was collated alongside postoperative outcomes (histology, recurrence, hypothyroidism). Comparison was made with the 2012 national survey. RESULTS Ninety-five cases of thyroglossal duct surgery in children and adults were studied. Demographic data were comparable to the literature. Ultrasonography was the most commonly used preoperative investigation. Histology of 71% of excised cysts confirmed TGDC with another 8% reported as development cysts. The excision of the cyst with a cuff of strap muscles and middle portion of hyoid bone had the lowest recurrence rate, which was 4% overall in this study. There were no cases of ectopic thyroid tissue or postoperative hypothyroidism. DISCUSSION AND CONCLUSION Nearly a decade of thyroglossal duct cyst excisions in a large-volume unit gave detail on actual preoperative practice and outcomes. Practice was found to be consistent overall with the 2012 recommendations although not standardised across all cases. From this experience, and a literature review, a visual guide on preoperative investigations for different age groups in the form of a flow chart is proposed to reduce risk of complications while avoiding unnecessary investigations.
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Affiliation(s)
| | - S Cole
- Queen's Medical Centre, UK
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Ahn D, Kwak JH, Lee GJ, Sohn JH. Ultrasound-Guided Ethanol Ablation as a Primary Treatment for Thyroglossal Duct Cyst: Feasibility, Characteristics, and Outcomes. Otolaryngol Head Neck Surg 2023; 168:1381-1388. [PMID: 36939631 DOI: 10.1002/ohn.231] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/11/2022] [Accepted: 11/28/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To evaluate the feasibility, characteristics, and outcomes of ultrasound-guided ethanol ablation (US-EA) as a primary treatment for thyroglossal duct cysts (TGDCs). STUDY DESIGN Prospective case series. SETTING Single center study. METHODS The inclusion criteria were as follows: (i) patients with TGDC aged ≥18 years, (ii) benign TGDC in imaging and cytological examinations, and (iii) patients' need for nonsurgical scarless treatment. US-EA was used as the primary treatment strategy. The primary outcome variables were the volume reduction rate (VRR) and cosmetic score at the last follow-up. RESULTS We enrolled 28 patients with TGDC. The median TGDC volume at baseline was 6.7 mL. The median procedure time of the US-EA was 6.5 minutes. The median volumes of the cyst aspirate and injected ethanol were 4.0 and 2.0 mL, respectively. Overall, 18, 8, and 2 patients underwent 1, 2, and 3 treatment sessions, respectively. There were no complications. The median VRR was 96.2%, and the treatment success rate was 96.4%. The World Health Organization cosmetic score decreased from 4 (baseline) to 1 (after treatment) in all patients. The subjective grade for cosmetic satisfaction was satisfactory or highly satisfactory in all patients. The VRR, treatment success rate, and the number of treatment sessions did not differ as functions of the characteristics of the TGDC, including the initial volume, septation, debris, or viscosity of the cyst fluid. CONCLUSION US-EA was feasible, safe, and effective in patients with TGDC. Therefore, US-EA can be used as a primary treatment for TGDC, evading general anesthesia and surgical scar.
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Affiliation(s)
- Dongbin Ahn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ji Hye Kwak
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Gil Joon Lee
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Ho Sohn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Thyroglossal Duct Lipoma: A Case Report and a Systematic Review of the Literature for Its Management. Diagnostics (Basel) 2023; 13:diagnostics13050932. [PMID: 36900076 PMCID: PMC10001181 DOI: 10.3390/diagnostics13050932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Thyroglossal duct (TGD) remnants in the form of cysts or fistulas usually present as midline neck masses and they are removed along with the central body of the hyoid bone (Sistrunk's procedure). For other pathologies associated with the TGD tract, the latter operation might be not necessary. In the present report, a case of a TGD lipoma is presented and a systematic review of the pertinent literature was performed. We present the case of a 57-year-old woman with a pathologically confirmed TGD lipoma who underwent transcervical excision without resecting the hyoid bone. Recurrence was not observed after six months of follow-up. The literature search revealed only one other case of TGD lipoma and controversies are addressed. TGD lipoma is an exceedingly rare entity whose management might avoid hyoid bone excision.
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10
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An unusual presentation of a thyroglossal duct cyst with cutaneous extrusion. OTOLARYNGOLOGY CASE REPORTS 2023. [DOI: 10.1016/j.xocr.2022.100497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Two-centre experience in the treatment of thyroglossal duct remnants using the modified muscle-sparing Sistrunk technique. Int J Oral Maxillofac Surg 2023:S0901-5027(23)00019-X. [PMID: 36764864 DOI: 10.1016/j.ijom.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
The Sistrunk procedure has long been the method of choice for treating patients with thyroglossal duct remnants (TDRs). However, the extent of the surgical resection in the suprahyoid segment of the TDR remains controversial, as this anatomical site is the origin of both disease recurrence and surgical morbidity. The aim of this two-centre retrospective cohort study was to investigate the outcomes of a modified muscle-sparing Sistrunk procedure in primary TDRs. The primary predictor was the surgical approach, and the outcome variable was the recurrence rate. A total of 110 consecutive patients (62 (56.4%) male, 48 (43.6%) female) who underwent a modified muscle-sparing Sistrunk procedure were included in the study. Their mean age at presentation was 26.9 ± 18.9 years. A modified muscle-sparing Sistrunk procedure using cold instruments, electrocautery, and a harmonic scalpel was performed in all patients. Recurrence was recorded in six (5.5%) patients. The median hospital stay was 2 days (range 1-7 days), and the median follow-up duration was 7 years (range 2-13 years). There was no significant difference in recurrence rate between the conventional and modified muscle-sparing Sistrunk procedure in primary TDRs. The study findings showed that the modified muscle-sparing Sistrunk procedure had low recurrence and complication rates in the context of primary TDR.
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Muacevic A, Adler JR, Ajagbe O, Ishola A. Management Outcome of Adult Thyroglossal Duct Cyst in a General Surgery Tertiary Practice in Sub-Saharan Africa, Nigeria. Cureus 2022; 14:e31833. [PMID: 36579290 PMCID: PMC9788839 DOI: 10.7759/cureus.31833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/24/2022] Open
Abstract
Thyroglossal duct cyst (TDC) is a rare condition in adults. This is a report of its presentation and standard treatment with good outcome in adults in a Sub-Saharan tertiary hospital. It is a retrospective review of five adult patients who were managed over a five-year period culled from archived records and casenotes. The three males and two females have a median age of 35 years and a range of 15-74 years. Each of them presented with anterior neck masses while one, in addition, had a painful swelling with a discharging sinus. The median duration of the symptoms was 4.5 years. Four of the cysts were in the infrahyoid location and all the patients had a Sistrunk operation. The median duration of follow-up was six months, without complications. Surgeons need to have a high level of suspicion for this condition in adults.
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Park SI, Baek JH, Chung SR, Choi YJ, Lee JH, Kim TY, Lee YM, Baek SM. Ethanol ablation for the treatment of thyroglossal duct cysts: follow-up results for longer than 2 years. Eur Radiol 2022; 32:3525-3531. [PMID: 34993573 DOI: 10.1007/s00330-021-08402-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the long-term efficacy and safety of ethanol ablation (EA) for the treatment of thyroglossal duct cysts (TGDCs). METHODS This retrospective study included 81 consecutive patients diagnosed with and treated for symptomatic TGDCs at two institutions between Jan 2008 and Oct 2018. Preprocedural evaluation included US assessment with calculation of the TGDC volume. EA was performed under US guidance using 99% ethanol. Post-treatment follow-up was scheduled within 3 months, 6 months, and then annually. Immediate success was defined as a volume reduction ratio (VRR; ratio of the volume difference after EA to the initial TGDC volume) > 50% within 3 months. Long-term success was defined as VRR > 50% or resolution or improvement of cosmetic problems and symptoms without recurrence at last follow-up. RESULTS Seventy-seven patients underwent EA, and outcomes were assessed in 68 patients with available follow-up data. The immediate success rate of the first EA was 81% (55/68), with a mean VRR within 3 months of 73% ± 31%. One patient (1.5%, 1/68) developed wound inflammation after the first EA. Forty-two patients were followed up for longer than 2 years. For the median follow-up of 69 months (range, 24-131 months), the long-term success rate was 83% (35/42), with a mean VRR at last follow-up of 81% ± 35%. No patients developed malignancy from the ablated TGDCs. CONCLUSIONS EA for treatment of TGDCs achieved acceptable rates of immediate and long-term efficacy with a low complication rate, and can be considered as a first-line treatment for the management of TGDCs. KEY POINTS • The immediate success rate of EA for the treatment of TGDCs was 81% (55/68), with a mean VRR within 3 months of 73% ± 31%. • For the median follow-up of 69 months (range, 24-131 months), the long-term success rate was 83% (35/42), with a mean VRR at last follow-up of 81% ± 35%. • No patients developed malignancy from the ablated TGDCs but one patient (1.5%, 1/68) developed wound inflammation after the first EA.
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Affiliation(s)
- Sang Ik Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-735, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-735, Korea.
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-735, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-735, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-735, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-735, Korea
| | - Yu-Mi Lee
- Division of Endocrine Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-735, Korea
| | - Seon Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Korea
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14
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Roh JL. Removal of Thyroglossal Duct Cyst by a Submental Approach. World J Surg 2022; 46:1431-1437. [PMID: 35195754 DOI: 10.1007/s00268-022-06493-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Thyroglossal duct cyst (TGDC) is the most common congenital cyst in the neck and is removed by the Sistrunk procedure. This surgery involves a horizontal skin incision over the cyst that may leave a noticeable scar on the front of the neck. Therefore, this study examined the clinical outcomes and cosmetic benefits of the Sistrunk procedure by an incision in the submental area that is not easily visible from the front. MATERIALS AND METHODS This observational study was performed on 152 patients who underwent the Sistrunk procedure by a submental approach to remove TGDC at a university medical center. Intraoperative findings, postoperative complications, subjective pain levels, and satisfaction with incision scars and neck and facial deformities, and recurrence were prospectively evaluated. RESULTS The length of the submental incision was about 3 cm and the median total operation time was 36 min. Postoperative complications were minimal. Hematoma occurred in two cases (1.3%), surgical site infection in 1 case (0.7%), and dysphagia for more than 1 week occurred in 1 case (0.7%). On a 0-10 visual analogue scale, the pain had a median value of 2 on the first day after surgery, and satisfaction with incision scars and neck and facial deformities showed median values of 8 and 10 at 6 months after surgery, respectively. Recurrence occurred in one patient (0.7%) during the median follow-up period of 68 months. CONCLUSIONS The submental approach for TGDC excision may be a reliable new surgical method that is safe and has cosmetic advantages. This observational study evaluated the clinical outcomes and cosmetic benefits of the Sistrunk procedure by a submental incision for thyroglossal duct cyst in 152 patients. The surgical procedure showed no increased operation time, no need for wide flap elevation, easy suprahyoid dissection, and an invisible scar in a natural position of the neck.
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Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, 13496, Republic of Korea.
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15
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Wang Y, Yang G. Optimal age of surgery for children with thyroglossal duct cysts: A single-institution retrospective study of 340 patients. Front Pediatr 2022; 10:1038767. [PMID: 36776677 PMCID: PMC9911228 DOI: 10.3389/fped.2022.1038767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/28/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The recommended age of surgery for thyroglossal duct cysts (TGDCs) in children is inconclusive. This study aimed to explore the optimal age of surgery by analyzing the natural history of the disease and the association between the age of surgery and postoperative complications. METHODS All TGDC patients who underwent a modified Sistrunk procedure at our hospital between March 2010 and May 2022 were reviewed retrospectively. The evaluation focused on the age of preoperative symptomatic cystic infection, pathological inflammation, postoperative wound infection, and recurrence. RESULTS Of the 340 patients included in the study, the median age of surgery was 47.5 months (IQR, 24.1-61.6). Preoperative symptomatic cystic infection and pathological inflammation frequencies were 27.1% (n = 92) and 48.5% (n = 165), respectively. The cumulative hazard of symptomatic cystic infection and pathological inflammation increased steadily with age. The ages of 50% cumulative incidence of symptomatic cystic infection and pathological inflammation were 97 months and 71 months, respectively. Postoperative wound infection was higher in patients of younger age (OR = 0.96, 95% CI, 0.93-0.98, P < 0.001) and with symptomatic cystic infection (OR = 8.16, 95% CI, 2.54-36.86, P = 0.002). There was no significant association between the age of surgery and recurrence. CONCLUSION Although wound infection was weakly associated with younger age, the symptomatic cystic infection increasing with age has a more remarkable impact on wound infection after the Sistrunk procedure. The recurrence rate did not increase in young patients receiving surgery. Therefore, the Sistrunk procedure was safe and effective at a young age, and prompt operation in children with TGDC once diagnosed was reasonable.
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Affiliation(s)
- Yingli Wang
- West China School of Nursing/Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
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16
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Caniglia AJ, Johnston DR, Rastatter JC, Maddalozzo J. Knowledge and Utilization of the Posterior Hyoid Space as Related to Excision of the Thyroglossal Duct Cyst. Laryngoscope 2021; 132:668-669. [PMID: 34581448 DOI: 10.1002/lary.29840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Alexander J Caniglia
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, U.S.A
| | - Douglas R Johnston
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, U.S.A
| | - Jeffrey C Rastatter
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, U.S.A
| | - John Maddalozzo
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, U.S.A
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17
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Chemical ablation using ethanol or OK-432 for the treatment of thyroglossal duct cysts: a systematic review and meta-analysis. Eur Radiol 2021; 31:9048-9056. [PMID: 34003346 DOI: 10.1007/s00330-021-08033-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/21/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To review the effectiveness and safety of chemical ablation using ethanol or OK-432 for the treatment of TGDCs (thyroglossal duct cysts). METHODS MEDLINE and EMBASE databases were searched up to May 29, 2020, to identify studies reporting the safety and efficacy of chemical ablation using ethanol or OK-432 for the treatment of TGDCs. The search query consisted of synonyms of thyroglossal duct cysts and ethanol or OK-432 ablation. The pooled success and complication rates were calculated using the inverse variance method to calculate weights, and pooled proportions were determined using the DerSimonian-Laird random-effects method. RESULTS Seven original articles including a total of 129 patients were included. The efficacy of chemical ablation was acceptable, with a pooled success rate of 70% (95% CI, 47-86%). The pooled success rate of ethanol ablation was superior to that of OK-432 ablation, although with equivocal statistical significance (84% vs. 51%, p = 0.055). Repeat ethanol ablation achieved a pooled success rate of 47% (95% CI, 24-71%). The chemical ablation procedures were safe, with a pooled major complication rate of 0.9% (95% CI, 0.1-5.8%). CONCLUSIONS Chemical ablation using ethanol or OK-432 for the treatment of TGDCs had acceptable success and low complication rates, and repeat treatment after initial failure was also feasible. In addition, it is an inexpensive and simple procedure and could therefore be considered a first-line treatment for TGDCs. KEY POINTS • The efficacy of chemical ablation using ethanol or OK-432 was acceptable, with a pooled success rate of 70% (95% CI, 47-86%). The pooled success rate of ethanol ablation was superior to that of OK-432 ablation, although with equivocal statistical significance (84% vs. 51%, p = 0.055). • Repeat ethanol ablation was also feasible, with a pooled success rate of 47% (95% CI, 24-71%). • The chemical ablation procedures were safe, with a pooled major complication rate of 0.9% (95% CI, 0.1-5.8%).
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18
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Ndegbu CU, Olasehinde O, Adeyemo A, Alatise OI, Amusa YB. Management of Thyroglossal Cyst in Adults: A Single-Institution Experience. Niger J Surg 2021; 27:38-41. [PMID: 34012240 PMCID: PMC8112365 DOI: 10.4103/njs.njs_25_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/05/2020] [Accepted: 06/01/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives: Thyroglossal duct cyst (TDC) is the most common congenital anterior neck mass in clinical practice. Due to its congenital origin, presentation in adulthood is uncommon with only 7% of cases presenting in this age group. Data are therefore limited on the management of TDC in adults, particularly in Sub-Saharan Africa. This study describes the pattern of the presentation and treatment outcomes, following the management of TDC in a series of adults in a Nigerian tertiary hospital. Subjects and Methods: A retrospective review of all adult patients with TDCs over a 5-year period was carried out. Sociodemographic data, operative details, and postoperative outcomes were obtained and presented as descriptive statistics. Results: Seven adult patients, including five males and two females, were managed during the period. Their ages ranged from 19 to 60 years, with a mean of 37 ± 16.4 years. All the patients presented with anterior neck swellings which had been present for a median duration of 3 years. Cysts were located in the infrahyoid position in all instances, and all had Sistrunk operation over a mean operative time of 78 ± 16 min. There were no intraoperative complications. The mean duration of the postoperative stay was 2 days. There was no recurrence after a median follow-up period of 15 months. Conclusion: This study highlights the rarity of TDC in adults and describes a single institution's experience with the management of adult cases of TDC using the classical Sistrunk operation.
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Affiliation(s)
| | - Olalekan Olasehinde
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.,Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Adekunle Adeyemo
- Department of Otorhinolaryngology, Obafemi Awolowo University, Ile-Ife, Nigeria.,Department of Otorhinolaryngology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olusegun I Alatise
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.,Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Yemisi B Amusa
- Department of Otorhinolaryngology, Obafemi Awolowo University, Ile-Ife, Nigeria.,Department of Otorhinolaryngology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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19
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Brooks JA, Cunningham MJ, Hughes AL, Kawai K, Dombrowski ND, Adil E. Postoperative Disposition Following Pediatric Sistrunk Procedures: A National Database Query. Laryngoscope 2021; 131:E2352-E2355. [PMID: 33427321 DOI: 10.1002/lary.29331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE/HYPOTHESIS Variability exists in the postoperative disposition of children following Sistrunk procedures. Management options include discharge home versus overnight observation, with the latter allowing monitoring for immediate postoperative complications, presumably reducing the need for subsequent readmission. This study investigates the association between overnight observation and ambulatory management of children undergoing Sistrunk procedures and relevant postoperative complication and revisit rates to clarify best practice for these patients. METHODS This was a retrospective database review using the Pediatric Health Information System database from 2007 to 2016. RESULTS The cited dataset identified 6,434 qualifying patients, categorized into ambulatory versus overnight observation cohorts. The overall 30-day revisit rate was 4.9%; the revisit rate with overnight observation (6.1%) was higher than for ambulatory patients (3.8%, adjusted odds ratio (OR) 1.60; 95% confidence interval (CI): 1.21, 2.12). Revisit rates were significantly higher in patients 2 years of age or younger compared to older patients (6.7% vs. 4.3%). The rates of return to the operating room for the observation versus ambulatory groups were 1.8% and 0.5%, respectively. Cervical fluid collection and neck swelling were among the most common revisit indications in both groups, with a mean time to presentation of 9 days. CONCLUSIONS This study demonstrates that ambulatory management following a Sistrunk procedure is not associated with increased rates of common postoperative complications, readmission, or need for secondary surgical intervention. A Sistrunk procedure may be safely performed on an ambulatory basis in select cases. LEVEL OF EVIDENCE IV Laryngoscope, 131:E2352-E2355, 2021.
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Affiliation(s)
- Jennifer A Brooks
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Michael J Cunningham
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Amy L Hughes
- Department of Otolaryngology, Connecticut Children's Medical Center University of Connecticut School of Medicine, Hartford, Connecticut, U.S.A
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Natasha D Dombrowski
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Eelam Adil
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
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20
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Foti J, Grimaldo F. Infected Recurrent Thyroglossal Duct Cyst: A Case Report. Clin Pract Cases Emerg Med 2020; 4:411-413. [PMID: 32926699 PMCID: PMC7434280 DOI: 10.5811/cpcem.2020.4.46863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/24/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction A thyroglossal duct cyst (TGDC) is a congenital malformation in the neck. Surgical management is often recommended due to risk of recurrent infections and rare possibility of malignancy. Case Report Herein, we describe the case of an adult presenting with tender neck mass and fever. She had a history of previous surgical excision of her TGDC as a child. On evaluation she was found to have a recurrent TGDC complicated by acute infection via computed tomography imaging. Conclusion In patients who have had previous surgical intervention to remove a TGDC, recurrence with infection should remain a diagnostic consideration.
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Affiliation(s)
- Jennifer Foti
- Naval Medical Center San Diego, Department of Emergency Medicine, San Diego, California
| | - Felipe Grimaldo
- Naval Medical Center San Diego, Department of Emergency Medicine, San Diego, California
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21
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Danau T, Verfaillie G, Gordts F, Rose T, De Backer A. Thyroglossal duct cysts in children: a 30-year survey with emphasis on clinical presentation, surgical treatment, and outcome. Acta Chir Belg 2019; 119:357-362. [PMID: 30388395 DOI: 10.1080/00015458.2018.1529345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Thyroglossal duct cysts (TGDC) are one of the most common congenital anomalies found in the anterior neck region of children. Sistrunk's procedure, described in 1920 already, is still considered as the gold standard. However, clinical reality shows that in a minority of patients, marsupialization and simple cyst excision are still performed as well. Cyst recurrence is the most feared complication. The main goal of this retrospective study is to determine risk factors of recurrence. Furthermore, data on presentation characteristics, management and outcome were collected as well. Methods: The data of 104 patients aged between 0 and 16 years who underwent surgery for TGDC at the University Hospital of Brussels between 1986 and 2016 were retrospectively analyzed. We focused on aspects of clinical presentation, intra- and postoperative treatment and long-term follow-up. Results: Overall recurrence of TGDC was seen in twelve of the 104 cases (11.5%). Eight out of these 12 showed a preoperative infection, 4 out of 12 had intra-operative cyst rupture. Five out of the 12 patients had not been treated by the Sistrunk procedure, but by cyst excision or marsupialization only. Non-adherence to the Sistrunk procedure appeared to be the only significant risk factor of TGDC recurrence. Conclusion: Our study shows that Sistrunk's operation for thyroglossal duct cyst in pediatric patients is significantly superior in reducing the risk of cyst recurrence compared to other surgical treatments. Preoperative infection and cyst rupture did not influence the recurrence rates.
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Affiliation(s)
- Tom Danau
- Department of Pediatric Surgery, University Hospital Vrije Universiteit Brussel, Brussels, Belgium
| | - Guy Verfaillie
- Department of Pediatric Surgery, University Hospital Vrije Universiteit Brussel, Brussels, Belgium
| | - Frans Gordts
- Department of ENT Surgery, University Hospital Vrije Universiteit Brussel, Brussels, Belgium
| | - Thomas Rose
- Department of Pediatric Surgery, University Hospital Vrije Universiteit Brussel, Brussels, Belgium
| | - Antoine De Backer
- Department of Pediatric Surgery, University Hospital Vrije Universiteit Brussel, Brussels, Belgium
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22
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Brooks JA, Cunningham MJ, Koempel JA, Kawai K, Huang JK, Weitzman RE, Osterbauer B, Hughes AL. To drain or not to drain following a Sistrunk procedure: A dual institutional experience. Int J Pediatr Otorhinolaryngol 2019; 127:109645. [PMID: 31494373 DOI: 10.1016/j.ijporl.2019.109645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION A Sistrunk procedure is the standard operative management of patients with thyroglossal duct cysts. Drain placement is commonly employed with the goal of reducing postoperative complications. This study investigates the association between drain use and relevant postoperative complications following pediatric Sistrunk procedures. METHODS Retrospective cohort study evaluating 295 pediatric patients treated between 2007 and 2016 at two tertiary care children's hospitals. RESULTS The mean age of the study population was 5.6 years (SD 4.0). A drain was utilized in 234 cases (79.3%). The mean procedural duration was 108 min (SD 48), and significantly longer in patients receiving a drain. Early postoperative complications included seroma (5.8%), secondary infection (3.4%), wound breakdown (2.0%) and hematoma (0.3%). The risk of such complications did not significantly differ between patients without drain placement (9.8%) versus those who underwent surgical drain placement (12.0%) after accounting for age and history of preoperative infection (adjusted RR = 0.86; 95% CI: 0.37, 1.98; p = 0.72). In the subgroup analysis, findings were consistent across institutions, age category, history of infection, and primary versus secondary procedure. CONCLUSION This dual institutional study found drain placement during a Sistrunk procedure may not reduce rates of common postoperative complications, even in longer duration cases in which a drain is more frequently placed. This data suggests a Sistrunk procedure may be safely performed without drain placement in select cases.
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Affiliation(s)
- Jennifer A Brooks
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Department of Otolaryngology, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
| | - Michael J Cunningham
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Department of Otolaryngology, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Jeffrey A Koempel
- Division of Otolaryngology, Children's Hospital Los Angeles, Department of Otolaryngology- Head & Neck Surgery University of Southern California, 4650 Sunset Avenue, Los Angeles, CA, 90027, USA
| | - Kosuke Kawai
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Department of Otolaryngology, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Jonathan K Huang
- Division of Otolaryngology, Children's Hospital Los Angeles, Department of Otolaryngology- Head & Neck Surgery University of Southern California, 4650 Sunset Avenue, Los Angeles, CA, 90027, USA
| | - Rachel E Weitzman
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Department of Otolaryngology, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Beth Osterbauer
- Division of Otolaryngology, Children's Hospital Los Angeles, Department of Otolaryngology- Head & Neck Surgery University of Southern California, 4650 Sunset Avenue, Los Angeles, CA, 90027, USA
| | - Amy L Hughes
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Department of Otolaryngology, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
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23
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Batazzi A, Leng S, Ghionzoli M, Lo Piccolo R, Martin A, Facchini F, Messineo A. Thyroglossal duct cyst: Factors affecting cosmetic outcome and recurrence. Pediatr Int 2019; 61:1020-1024. [PMID: 31282046 DOI: 10.1111/ped.13955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 04/09/2019] [Accepted: 05/24/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Thyroglossal duct cyst (TDC) is the most common congenital abnormality in the neck in children. The purpose of this study was to perform a comprehensive review of all cases of TDC surgically treated at a single institution and to evaluate the factors that influence the rate of recurrence, and the aesthetic outcome of the surgery on follow up. METHODS All cases of TDC surgically treated at the Department of Pediatric Surgery at Meyer Hospital from January 2005 to December 2016 were selected. Charts from 248 patients were reviewed and risk factors for recurrence evaluated. A questionnaire was submitted to the patients' parents to determine if postoperative complications were present and standardized neck pictures were requested, to evaluate the cosmetic result . Microsoft Office Excel 2007 for Windows and Graphpad Prism 6 were used for data management and statistical analysis. RESULTS Simple cyst excision and post-inflammatory fibrosis (P < 0.05) were assessed as important risk factors for the recurrence of TDC. Recurrence rate on Sistrunk procedure was 5%. Variables such as post-inflammatory fibrosis before surgery (P < 0.001), the positioning of a drain (P < 0.01) and the development of recurrence (P < 0.001), negatively influenced the cosmetic result. No thyroglossal duct cyst carcinoma and no long-term postoperative complications were observed. CONCLUSIONS Recurrence rates were higher in patients who underwent simple cyst excision instead of the Sistrunk procedure, as already reported in literature. Presence of post-inflammatory fibrosis and positioning of the drain at surgery were associated with higher rates of recurrence, as well as worse cosmetic outcome.
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Affiliation(s)
- Andrea Batazzi
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Stella Leng
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Roberto Lo Piccolo
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Alessandra Martin
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Flavio Facchini
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Antonio Messineo
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
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24
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Lekkerkerker I, van Heurn EL, van der Steeg AF, Derikx JP. Pediatric thyroglossal duct cysts: Post-operative complications. Int J Pediatr Otorhinolaryngol 2019; 124:14-17. [PMID: 31153090 DOI: 10.1016/j.ijporl.2019.05.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Thyroglossal duct cysts (TGDCs) result from incomplete involution of the thyroglossal duct and are resected with a Sistrunk-procedure. We studied and graded severity of postoperative complications in children who underwent this procedure, with corresponding risk factors. METHODS In our electronic health record system we reviewed the medical records of all patients aged <18 years, with surgically treated TGDC between 01-01-2005 and 31-12-2015 in two university hospitals. Risk factors (age, gender, recurrence at presentation, treatment hospital, cyst inflammation, cyst rupture, drain placement, antibiotics or postoperative infection) were studied by univariate analysis. The Clavien-Dindo surgical complication classification was used as postoperative surgical grading system. RESULTS Of the ninety-one patients, with a mean age of 4.4 years, seven were referred from other hospitals with a recurrent TGDC. 24 patients (26.4%) had a complication. Hemorrhage and resection of thyroid cartilage were the most severe complications. Recurrence and wound infection (both n = 7, 7.7%) were most common. We could not identify risk factors for these complications. CONCLUSIONS The treatment of children with thyroglossal duct cysts shows a considerable amount of complications. Pre-selected risk factors did not show any significant correlation with these complications.
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Affiliation(s)
- Iris Lekkerkerker
- Paediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC & VU University Medical Center, P.O.Box 22660, 1100, DD, Amsterdam, the Netherlands.
| | - Ernest Lw van Heurn
- Paediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC & VU University Medical Center, P.O.Box 22660, 1100, DD, Amsterdam, the Netherlands
| | - Alida Fw van der Steeg
- Paediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC & VU University Medical Center, P.O.Box 22660, 1100, DD, Amsterdam, the Netherlands
| | - Joep Pm Derikx
- Paediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC & VU University Medical Center, P.O.Box 22660, 1100, DD, Amsterdam, the Netherlands
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25
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Booth R, Tilak AM, Mukherjee S, Daniero J. Thyroglossal duct cyst masquerading as a laryngocele. BMJ Case Rep 2019; 12:12/3/e228319. [PMID: 30914413 DOI: 10.1136/bcr-2018-228319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thyroglossal duct cysts (TGDCs) are the most common congenital neck mass and often present in the paediatric population as a painless mass in the midline. A lateralised neck mass presenting for the first time in an adult may raise more concern for malignancy or a laryngocele. A 50-year-old man presented with an asymptomatic right level II neck mass adjacent to the thyroid cartilage. Preoperative CT revealed a cystic mass right of the midline with an intralaryngeal component. Intraoperatively, the lesion tracked towards the central hyoid bone; a Sistrunk procedure was performed. Postoperative pathology revealed a small foci of thyroid tissue within the mass. Careful consideration of the origin of this unusually presenting TGDC enabled appropriate operative management.
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Affiliation(s)
- Renee Booth
- Department of Otolaryngology, Augusta University, Augusta, Georgia, USA
| | | | - Sugoto Mukherjee
- Radiology, University of Virginia, Charlottesville, Virginia, USA
| | - James Daniero
- Department of Otolaryngology, University of Virginia, Charlottesville, Virginia, USA
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26
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Anderson JL, Vu K, Haidar YM, Kuan EC, Tjoa T. Risks and complications of thyroglossal duct cyst removal. Laryngoscope 2019; 130:381-384. [PMID: 30865298 DOI: 10.1002/lary.27918] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 01/21/2019] [Accepted: 02/19/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES/HYPOTHESIS Thyroglossal duct cysts (TGDCs) are the most common congenital neck cyst and typically present in childhood or adolescence, although a subset remains asymptomatic until adulthood. Although treatment involves surgical excision, few large-scale studies exist regarding the risks of surgical treatment of TGDCs in adults. This study aims to describe the characteristics of adult patients undergoing TGDC excision and to analyze risk factors associated with reoperation or other postoperative complications. STUDY DESIGN Retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. METHODS Patients age ≥ 18 years in the NSQIP database who underwent TGDC removal from 2005 to 2014 were included. Covariates included patient demographics, comorbidities, preoperative variables, and intraoperative variables. Outcomes included reoperation, complications, and length of hospital stay. RESULTS A total of 793 cases met inclusion criteria. Patients were predominantly female (57.0%) and white (64.3%), with a mean age of 44.3 years. Thirty-day mortality did not occur in this cohort, but 3.0% of patients experienced at least one complication. Forty-eight patients (6.1%) underwent reoperation. Wound infection rates were higher in revision operations compared with primary operations (8.3% and 0.9%, respectively; P = .003). Low preoperative sodium was associated with reoperation (P = .047). Additionally, length of hospital stay was associated with increased total operative time (P = .02). CONCLUSIONS TGDC excision is a safe and well-tolerated procedure in the adult population, with low complication rates. However, the risk of reoperation, surgical-site infections, and medical complications should be taken into consideration during preoperative planning. LEVEL OF EVIDENCE NA Laryngoscope, 130:381-384, 2020.
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Affiliation(s)
- Jennifer L Anderson
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California.,and the Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Kimberly Vu
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
| | - Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
| | - Tjoson Tjoa
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
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Farquhar D, Rawal R, Masood M, McClain W, Kilpatrick L, Rose A, Zdanski C. Outpatient management and surgeon specialty for thyroglossal duct cyst excision: A retrospective analysis of 377 patients and 30-day outcomes in the American College of Surgeons NSQIP-P Database. Clin Otolaryngol 2018; 43:1402-1406. [DOI: 10.1111/coa.13170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
- D.R. Farquhar
- Department of Otolaryngology/Head and Neck Surgery; University of North Carolina at Chapel Hill School of Medicine; Chapel Hill NC USA
| | - R.B. Rawal
- Department of Otolaryngology/Head and Neck Surgery; University of North Carolina at Chapel Hill School of Medicine; Chapel Hill NC USA
| | - M.M. Masood
- Department of Otolaryngology/Head and Neck Surgery; University of North Carolina at Chapel Hill School of Medicine; Chapel Hill NC USA
| | - W.G. McClain
- Department of Otolaryngology/Head and Neck Surgery; University of North Carolina at Chapel Hill School of Medicine; Chapel Hill NC USA
| | - L.A. Kilpatrick
- Department of Otolaryngology/Head and Neck Surgery; University of North Carolina at Chapel Hill School of Medicine; Chapel Hill NC USA
| | - A.S. Rose
- Department of Otolaryngology/Head and Neck Surgery; University of North Carolina at Chapel Hill School of Medicine; Chapel Hill NC USA
| | - C.J. Zdanski
- Department of Otolaryngology/Head and Neck Surgery; University of North Carolina at Chapel Hill School of Medicine; Chapel Hill NC USA
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Nightingale M. Midline cervical swellings: What a paediatrician needs to know. J Paediatr Child Health 2017; 53:1086-1090. [PMID: 29148189 DOI: 10.1111/jpc.13759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 08/25/2017] [Accepted: 08/29/2017] [Indexed: 11/30/2022]
Abstract
Midline cervical swellings are a heterogeneous group of conditions in children. Careful clinical examination will allow a diagnosis to be made in many instances and appropriate investigations to be performed before referral to surgical services. The approach to clinical examination, investigation and management of the most common conditions is described.
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Affiliation(s)
- Michael Nightingale
- Paediatric Surgery, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
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Kayhan FT, Yigider AP, Koc AK, Kaya KH, Erdim I. Treatment of tongue base masses in children by transoral robotic surgery. Eur Arch Otorhinolaryngol 2017. [PMID: 28625010 DOI: 10.1007/s00405-017-46-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The feasibility and effectiveness of transoral robotic surgery (TORS) in children with tongue base masses (TBMs) were evaluated. Eight pediatric patients who were treated with TORS for TBMs between January 2010 and January 2016 at a tertiary hospital included in the study. All pathologies were congenital lesions: four were lingual thyroglossal ductus cysts (LTGDCs), one was a minor salivary gland tumor, one was a vallecular cyst, one was a bronchogenic cyst, and one was an ectopic thyroid tissue. TORS was performed successfully in all cases. The mean robotic set-up and exposure time was 13.0 ± 2.1 min (range 10-16 min) and the mean robotic surgery time was 8.8 ± 6.9 min (range 4-25 min). Estimated blood loss was lower than 5 ml for one patient and lower than 50 ml for another one. The remaining patients' estimated blood loss was lower than 10 ml. No patient required tracheostomy intra- or post-operatively. Only one minor complication occurred on day 10 after surgery (minor bleeding), which was resolved without intervention. No major complications or recurrence were observed. Better visualization and small, flexible arms allow surgeons to treat TBM faster and easily using TORS. This leads to decreased morbidity compared to open and transoral endoscopic/microscopic surgical methods. In the future, we believe that TORS may become the gold standard method for the treatment of pediatric TBM with continued development of robotic technology.
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Affiliation(s)
- Fatma Tulin Kayhan
- Otorhinolaryngology and Head and Neck Surgery Clinic, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ayse Pelin Yigider
- Otorhinolaryngology and Head and Neck Surgery Clinic, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Arzu Karaman Koc
- Otorhinolaryngology and Head and Neck Surgery Clinic, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Kamil Hakan Kaya
- Otorhinolaryngology and Head and Neck Surgery Clinic, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ibrahim Erdim
- Otorhinolaryngology and Head and Neck Surgery Clinic, Gaziosmanpasa University Medical Faculty, Tokat, Turkey.
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Kayhan FT, Yigider AP, Koc AK, Kaya KH, Erdim I. Treatment of tongue base masses in children by transoral robotic surgery. Eur Arch Otorhinolaryngol 2017. [DOI: 10.1007/s00405-017-4646-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Five-years' experience with outpatient thyroglossal duct cyst surgery. Int J Pediatr Otorhinolaryngol 2017; 96:65-67. [PMID: 28390616 DOI: 10.1016/j.ijporl.2017.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Many pediatric surgeons feel uncomfortable doing Sistrunk procedure without drain placement and in an outpatient setting. This study aimed to review our pediatric surgery department's experience in managing thyroglossal duct cyst surgery and to prove feasibility and safety of Sistrunk procedure without drain placement in an outpatient setting. METHODS A retrospective review was performed of all patients who underwent Sistrunk procedure, between January 2011 and December 2015, in our department. RESULTS A total of 36 patients were included, with age ranging from 1 to 14 years (mean 6.3 years). Sixteen patients underwent day surgery, and 20 stayed overnight (with less than 24 h postoperative discharge). The main reason to stay overnight was distance (greater than 60 km or 1 h driving) between the hospital and patient's residence. All patients had histopathological confirmation of the diagnosis. None of the patients had a drain placed intraoperatively. There was only one readmission at 48 h postoperative; a patient who underwent day surgery came back with cervical edema, which resolved with non-operative treatment. Short-term complications included post-operative local wound infection (8,5%) and hematoma (2,9%), none of which required surgical treatment. CONCLUSIONS Sistrunk procedure without drain placement is safe and can be performed in an outpatient setting.
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Miller ML, Peterson ME, Randolph JF, Broome MR, Norsworthy GD, Rishniw M. Thyroid Cysts in Cats: A Retrospective Study of 40 Cases. J Vet Intern Med 2017; 31:723-729. [PMID: 28382700 PMCID: PMC5435053 DOI: 10.1111/jvim.14706] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/07/2017] [Accepted: 02/27/2017] [Indexed: 11/28/2022] Open
Abstract
Background Thyroid cysts are rare in cats and poorly documented. Objectives To report distinguishing clinical features and treatment responses of cats with thyroid cysts. Animals Forty client‐owned cats. Methods Retrospective review of medical records for cats with thyroid cysts confirmed by scintigraphy, ultrasound, magnetic resonance imaging, or necropsy at 4 referral centers between 2005 and 2016. Signalment, clinical findings, diagnostic testing, treatment, and outcome were recorded. Results Cats ranged in age from 8 to 20 years with no apparent breed or sex predilection. 37 of 40 (93%) cats were hyperthyroid (duration, 1–96 months). Clinical findings included palpable neck mass (40/40, 100%), weight loss (15/40, 38%), dysphagia (8/40, 20%), decreased appetite (5/40, 13%), and dyspnea (4/40, 10%). Cysts were classified as small (≤8 cm3) in 16 (40%) and large (>8 cm3) in 24 (60%) cats. Of 25 cats treated with radioiodine, hyperthyroidism resolved in 23 (92%), whereas thyroid cysts resolved in 12 (50%). Radioiodine treatment resolved small cysts in 8 of 13 (62%) cats and large cysts in 4 of 11 (36%) cats. Eight cats, including 2 euthyroid cats, underwent thyroid‐cystectomy; 3 with bilateral thyroid involvement were euthanized postoperatively for hypocalcemia. Excised cystic thyroid masses were identified as cystadenoma (4) and carcinoma (4). Conclusions and Clinical Importance Thyroid cysts are encountered in hyperthyroid and euthyroid cats with benign and malignant thyroid tumors. Radioiodine treatment alone inconsistently resolved thyroid cysts. Thyroid‐cystectomy could be considered in cats with unilateral thyroid disease or when symptomatic cysts persist despite successful radioiodine treatment of hyperthyroidism.
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Affiliation(s)
- M L Miller
- Department of Clinical Science, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | | | - J F Randolph
- Department of Clinical Science, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - M R Broome
- Advanced Veterinary Medical Imaging, Tustin, CA
| | | | - M Rishniw
- Department of Clinical Science, College of Veterinary Medicine, Cornell University, Ithaca, NY
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A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts. Head Neck Pathol 2016; 10:465-474. [PMID: 27161104 PMCID: PMC5082048 DOI: 10.1007/s12105-016-0724-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
The clinical features of thyroglossal duct remnant cysts (TGDC) have been well described, however the histopathologic aspects of these lesions have not been addressed in a detailed manner. In particular, there has been no large community practice based series evaluating TGDC histologically compared with management outcomes. A retrospective review of all TGDC diagnosed between 2005 and 2015 was performed. Six hundred eighty-five patients were identified (344 males; 341 females). Age at presentation was bimodal (first and fifth decades) and ranged from 0.8 to 87 years (mean 31.3 years). Males predominate in children (150:111); females in adults (230:194). Patients presented most frequently with a mobile midline neck mass in an infrahyoid location. An associated skin fistula (n = 67) was twice as common in pediatric as adult patients. The average cyst size was 2.4 cm (range 0.4-9.9 cm) by imaging studies and 2.6 cm (range 0.2-8.5 cm) by pathologic examination; pediatric patients had smaller cysts (mean 2.1 cm) than adults (mean 2.8 cm). Histologically, 257 (38 %) TGDC were lined by respiratory epithelium alone, 68 (10 %) squamous epithelium alone, 347 (51 %) exhibited both respiratory and squamous epithelium, and 13 (1 %) had no identifiable epithelial lining. Four hundred eighty-four (71 %) TGDC had associated thyroid gland tissue present within the cyst wall (n = 282), skeletal muscle (n = 71), adipose tissue (n = 34), or a combination of these sites (n = 97). The hyoid bone was identified in 647 (grossly and/or histologically), and absent in 38. Surgical management consisted of Sistrunk procedure (n = 647), cystectomy (n = 31), or thyroidectomy/thyroid lobectomy (n = 7). Treatment related complications were observed in 6 patients, which included vocal cord damage, seroma, and hematoma. Recurrences developed in 20 (3 %) patients, 14 of whom were managed initially by cystectomy. Papillary thyroid carcinoma was identified in 22 (3.2 %) TGDC. In summary, TGDC show a bimodal peak in the 1st and 5th decades, commonly presenting as a midline cervical lesion below the hyoid bone, associated with a skin fistula in 10 %. Histologically TGDC are most commonly lined by a combination of respiratory and squamous epithelium. Thyroid gland tissue is identified in 71 % of cases (0.45 cm mean size), although not limited to the cyst wall, but present in the surrounding soft tissues. Rare TGDC may harbor malignancy (3.2 %). TGDC are most effectively managed by Sistrunk procedure rather than excision, which carries low rates of complications (1 %) and recurrence (3 %).
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Abstract
Stridor is a variably pitched respiratory sound, caused by abnormal air passage during breathing and often is the most prominent sign of upper airway obstruction. It is usually heard on inspiration (typically resulting from supraglottic or glottic obstruction) but also can occur on expiration (originating from obstruction at or below glottic level and/or severe upper airway obstruction). Stridor due to congenital anomalies may exist from birth or may develop within days, weeks or months. Various congenital and acquired disorders prevail in neonates, infants, children, and adolescents, and have to be distinguished. History, age of the child and physical examination together often allow a presumptive diagnosis. Further investigations may be necessary to establish a definite diagnosis, and flexible airway endoscopy is the diagnostic procedure of choice in most circumstances ("stridor is visible").
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Affiliation(s)
- Andreas Pfleger
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Austria
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Austria.
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