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Spinelli C, Ghionzoli M, Ugolini C, Oreglio C, Guglielmo C, Morabito A, Patrizio A, Fallahi P, Ferrari SM, Antonelli A. Does thyroglossal duct arborization play a role in the post-surgical outcome of Sistrunk procedure in children? Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08631-y. [PMID: 38594507 DOI: 10.1007/s00405-024-08631-y] [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: 10/04/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE The purpose of the present study is to analyze thyroglossal duct cyst (TGDC) histopathological features, with focus on "arborization", in a cohort of pediatric patients who underwent surgical removal, and evaluate a possible correlation with clinical recurrences. METHODS A retrospective analysis of all patients who underwent surgical resection for TGDC at the division of Pediatric Surgery of the University of Pisa from 2015 to 2020 was performed; for each patient, the following data were recorded: age, sex, clinical presentation, localization, size of the lesion, diagnostic tools, histopathological features, perioperative complications, recurrence and follow-up. RESULTS With respect to arborization, following histopathological analysis 25/30 patients (83.3%) presented thyroglossal duct branching. After a median follow-up of 3.5 years, only 2 out of 30 patients (6.7%), one male and one female, respectively aged 4 y.o. and 6 y.o., presented recurrence within one year from first surgery. CONCLUSION Surgery for TGDC remains a challenge for pediatric surgeons, while arborization was present in most of our cases which underwent surgery. With respect to the role of arborization, our study did not highlight sufficient conclusive data regarding their role in recurrence: instead, it showed wide resection as satisfactory, being the arborization present in most of the cases at histopathology.
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Affiliation(s)
- Claudio Spinelli
- Division of Pediatric and Adolescent Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Marco Ghionzoli
- Division of Pediatric and Adolescent Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Clara Ugolini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italia
| | - Chiara Oreglio
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Carla Guglielmo
- Division of Pediatric and Adolescent Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Armando Patrizio
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Alessandro Antonelli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italia.
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Frauenfelder C, Shelmerdine SC, Simcock IC, Hall A, Hutchinson JC, Ashworth MT, Arthurs OJ, Butler CR. Micro-CT Imaging of Pediatric Thyroglossal Duct Cysts: A Prospective Case Series. Front Pediatr 2021; 9:746010. [PMID: 34557462 PMCID: PMC8453197 DOI: 10.3389/fped.2021.746010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/16/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives: To determine the feasibility of micro-CT as a high-resolution 3D imaging tool for thyroglossal duct cysts and to evaluate its role augmenting traditional histopathological examination of resected specimens. Methods: A single centre, prospective case series of consecutive children undergoing excision of a thyroglossal duct cyst was performed at a quaternary paediatric referral hospital in the United Kingdom. Consecutive children listed for excision of a thyroglossal duct cyst whose parents agreed to participate were included and there were no exclusion criteria. Results: Surgically excised thyroglossal duct cyst or remnant specimens from five patients (two males, three females) were examined using micro-CT alongside traditional histopathological examination. In all cases, micro-CT imaging was able to demonstrate 3D imaging datasets of the specimens successfully and direct radio-pathological comparisons were made (Figures 1-5, Supplementary Video 1). Conclusions: The study has shown the feasibility and utility of post-operative micro-CT imaging of thyroglossal duct cysts specimens as a visual aid to traditional histopathological examination. It better informs the pathological specimen sectioning using multi-planar reconstruction and volume rendering tools without tissue destruction. In the complex, often arborised relationship between a thyroglossal duct cyst and the hyoid, micro-CT provides valuable image plane orientation and indicates proximity of the duct to the surgical margins. This is the first case series to explore the use of micro-CT imaging for pediatric thyroglossal duct specimens and it informs future work investigating the generalizability of micro-CT imaging methods for other lesions, particularly those from the head and neck region where precisely defining margins of excision may be challenging.
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Affiliation(s)
- Claire Frauenfelder
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,Discipline of Surgery, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Ian C Simcock
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Andrew Hall
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - John Ciaran Hutchinson
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom.,Department of Histopathology, St Thomas' Hospital, London, United Kingdom
| | - Michael T Ashworth
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Colin R Butler
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom
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Koempel JA, Brooks J, Snow MH, Osterbauer B, Garcia E, Bawab R, Shows J, Parham D. The Relevance of and Surgical Approach to the Suprahyoid Region in Thyroglossal Duct Surgery. Laryngoscope 2020; 131:553-558. [PMID: 32668033 DOI: 10.1002/lary.28887] [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: 04/03/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Persistent or recurrent disease following excision of a thyroglossal duct cyst/sinus (TGDC) is often found in the suprahyoid region. Cadaver dissections were performed to identify and name important surgical landmarks in the suprahyoid area; a histopathologic analysis of surgical specimens was completed to determine the incidence and extent of microscopic disease; and clinical outcomes were compared to determine the efficacy of a specific anatomic dissection. STUDY DESIGN Retrospective case series. METHODS Standardized dissections of four adult cadavers were performed. Consecutive surgical specimens were examined for evidence of microscopic TDGC disease in the suprahyoid region, measuring the greatest width and length of disease. A retrospective review of all consecutive TGDC procedures was completed. RESULTS The important surgical landmarks in the suprahyoid area were identified in all cadavers. Microscopic disease in the suprahyoid area was found in 79% (37 of 47) of surgical specimens. The mean greatest length and width of microscopic disease was 12.4 mm and 1.4 mm, respectively. Following identification of these landmarks, the incidence of recurrent or persistent disease decreased (P = .02) from 5% (8 of 159) to 0% (0 of 112). CONCLUSION The majority of pediatric patients with a TGDC will have microscopic disease in the suprahyoid area. The surgical landmark of the fascial plane between the geniohyoid and genioglossus muscles demarcates the anterior and lateral borders of resection in the suprahyoid area. This approach can be used as a reliable and easily reproducible technique in TGDC surgery to increase confidence of achieving complete removal of disease in the suprahyoid area, avoiding persistent or recurrent disease and a revision procedure. LEVEL OF EVIDENCE 4 Laryngoscope, 131:553-558, 2021.
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Affiliation(s)
- Jeffrey A Koempel
- Division of Otolaryngology - Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California, U.S.A
| | - Jennifer Brooks
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mikel H Snow
- Department of Cell and Neurobiology, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A
| | - Beth Osterbauer
- Division of Otolaryngology - Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California, U.S.A
| | - Erick Garcia
- Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A
| | - Ramzi Bawab
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, U.S.A
| | - Jared Shows
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, U.S.A
| | - David Parham
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, U.S.A
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Huang J, Osterbauer B, Koempel J. Prevalence of an intact hyoid bone at revision excision of a thyroglossal duct remnant. Int J Pediatr Otorhinolaryngol 2018; 113:131-133. [PMID: 30173971 DOI: 10.1016/j.ijporl.2018.07.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To determine the prevalence of an intact hyoid bone at the time of revision thyroglossal duct cyst (TGDC) surgery in a pediatric population. METHODS The operative reports of 44 patients under 18 years of age who underwent a revision TGDC surgery from March 1997 to October 2015 at Children's Hospital Los Angeles were reviewed to determine finding of an intact hyoid bone at the time of the revision procedure. RESULTS At the time of the revision surgery, 75% of the patients had an intact hyoid bone and 25% did not. CONCLUSION Patients who experience a recurrence of a TGDC are more likely than not to have an intact hyoid bone at revision surgery. These data indicate that some surgeons are not following the recommendation from Schlange and Sistrunk that removal of the mid-portion of the hyoid bone should be a routine part of any primary procedure for excision of a known or suspected TGDC in order to decrease the risk of recurrence. Despite the prevalent knowledge that the central portion of the hyoid bone be removed during a TGDC procedure, special attention should be given to the area of the midportion of the hyoid bone as a likely site of persistent disease in revision cases even if a previous operative report documents resection of a portion of the hyoid bone and/or cartilage.
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Affiliation(s)
- Jonathan Huang
- University of Southern California Keck School of Medicine, 1975 Zonal Ave Los Angeles, CA 90033, United States.
| | - Beth Osterbauer
- Children's Hospital Los Angeles, Division of Otolaryngology - Head and Neck Surgery, 4650 Sunset Blvd. Mailstop #58 Los Angeles, CA 90027, United States.
| | - Jeffrey Koempel
- Children's Hospital Los Angeles, Division of Otolaryngology - Head and Neck Surgery, 4650 Sunset Blvd. Mailstop #58 Los Angeles, CA 90027, United States.
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Garcia E, Osterbauer B, Parham D, Koempel J. The incidence of microscopic thyroglossal duct tissue superior to the hyoid bone. Laryngoscope 2018; 129:1215-1217. [PMID: 30194760 DOI: 10.1002/lary.27291] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Erick Garcia
- University of Southern California Keck School of MedicineLos Angeles California U.S.A
| | - Beth Osterbauer
- Division of Otolaryngology–Head and Neck SurgeryLos Angeles California U.S.A
| | - David Parham
- Department of Pathology and Laboratory MedicineChildren's Hospital Los AngelesLos Angeles California U.S.A
| | - Jeffrey Koempel
- Division of Otolaryngology–Head and Neck SurgeryLos Angeles California U.S.A
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Leach L, Jonas N. A rare case of a lingual mass in a neonate. J Surg Case Rep 2018; 2018:rjy059. [PMID: 29644040 PMCID: PMC5887301 DOI: 10.1093/jscr/rjy059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/10/2018] [Indexed: 11/16/2022] Open
Abstract
A large lingual cyst was noted on the 22-week antenatal ultrasound, which grew in proportion to the foetus on serial imaging. An elective c-section was performed in view of possible airway obstruction, and the neonate initially required oxygen to maintain saturations. Aged 1 month, the baby developed significant breastfeeding difficulties secondary to rapid cyst and secondary tongue enlargement, completely filling the oral cavity. Fifteen millilitres of fluid were aspirated in clinic, resulting in reduction of tongue size and immediate improvement in feeding. The patient subsequently underwent surgical excision of the cyst, which filled most of the anterior two-thirds of the tongue up to the foramen caecum. Histology supported the diagnosis of lingual thyroglossal duct cyst. A rare variant of thyroglossal duct cysts, these cysts can be potentially difficult to manage. More commonly located in the tongue base, we present an even rarer variant, that of an anterior tongue cyst.
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Affiliation(s)
- Laura Leach
- Department of ENT, Addenbrooke’s Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Nico Jonas
- Department of ENT, Addenbrooke’s Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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A 16-year experience in treating thyroglossal duct cysts with a “conservative” Sistrunk approach. Eur Arch Otorhinolaryngol 2015; 273:1019-25. [DOI: 10.1007/s00405-015-3571-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
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9
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Koempel JA. Thyroglossal duct remnant surgery: a reliable, reproducible approach to the suprahyoid region. Int J Pediatr Otorhinolaryngol 2014; 78:1877-82. [PMID: 25193588 DOI: 10.1016/j.ijporl.2014.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/12/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recurrence of thyroglossal duct remnants remains a clinical problem despite the success of the Sistrunk procedure. Inadequate excision of disease in the suprahyoid region significantly impacts disease recurrence. The primary aim of this study is to describe and present the author's experience with a simple, reliable, and reproducible approach to the suprahyoid area in a Sistrunk procedure. METHODS A retrospective review of the surgical management of thyroglossal duct remnants by a single surgeon at the Children's Hospital Los Angeles over a 16-year period was performed. Demographic and clinical data including disease recurrence and other complications were collected. Recurrence rates before and after the consistent application of a modified Sistrunk procedure were compared. RESULTS 94 patients (54% female and 46% male; mean age 5.2 years) met the inclusion criteria for this study. Overall recurrence rate following a Sistrunk procedure was 2.2%; 11.1% prior to 2004 and 0% after 2004, following consistent implementation of the surgical approach to the suprahyoid region as detailed in this study. Complications were minor and mean follow-up was 5.4 months. CONCLUSIONS The author has described a simple, reproducible, and reliable approach to the suprahyoid area in a Sistrunk procedure that limits incomplete excision with minimal risk for complications. This approach to the suprahyoid region should be considered for routine use in the management of both primary and revision thyroglossal duct remnants.
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Affiliation(s)
- Jeffrey A Koempel
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, 4650 Sunset Boulevard Mail Stop #58, Los Angeles, CA 90027, United States.
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10
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Hong P. Is drain placement necessary in pediatric patients who undergo the Sistrunk procedure? Am J Otolaryngol 2014; 35:628-30. [PMID: 24888796 DOI: 10.1016/j.amjoto.2014.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/26/2014] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Paul Hong
- IWK Health Centre, Department of Surgery and the School of Human Communication Disorders, Dalhousie University, Halifax, Nova Scotia, Canada.
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Gioacchini FM, Alicandri-Ciufelli M, Kaleci S, Magliulo G, Presutti L, Re M. Clinical presentation and treatment outcomes of thyroglossal duct cysts: a systematic review. Int J Oral Maxillofac Surg 2014; 44:119-26. [PMID: 25132570 DOI: 10.1016/j.ijom.2014.07.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 07/03/2014] [Accepted: 07/14/2014] [Indexed: 11/16/2022]
Abstract
The aim of the present review was to analyze the main clinical signs and symptoms observed in patients with thyroglossal duct cysts (TGDCs). Secondarily we investigated the outcomes following the different types of treatment of TGDCs in children and adults. Three selected strings were run on the PubMed database to retrieve articles on these topics. A double cross-check was performed on citations and full-text articles were identified using the study inclusion and exclusion criteria. A meta-analysis was performed of the data obtained. Overall, 356 articles were identified; 24 (comprising a total of 1371 subjects) satisfied the inclusion and exclusion criteria. On the basis of the meta-analysis, the presence of a neck cystic mass was the main clinical presentation of TGDCs, with a mean rate of 75% (95% confidence interval 72-79%). The mean local wound infection rate was 4% (95% confidence interval 3-6%), this being the most frequent complication following treatment. The mean rate of overall recurrence was 11% (95% confidence interval 9-14%). The Sistrunk procedure appears to be the better choice for the therapy of TGDCs to avoid recurrences. Further studies on larger cohorts of patients regarding the minimally invasive treatment options would be helpful to elucidate and endorse their utilization in selected cases.
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Affiliation(s)
- F M Gioacchini
- Otolaryngology Department, University Hospital of Modena, Modena, Italy.
| | | | - S Kaleci
- Department of Diagnostic Medicine, Clinical and Public Health University Hospital of Modena, Modena, Italy
| | - G Magliulo
- Department of Otorhinolaryngology "G. Ferreri", "La Sapienza" University, Rome, Italy
| | - L Presutti
- Otolaryngology Department, University Hospital of Modena, Modena, Italy
| | - M Re
- Otorhinolaryngology Department, Marche Polytechnic University, Ancona, Italy
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A ten-year experience of thyroglossal duct cyst surgery in children. Eur Arch Otorhinolaryngol 2013; 270:2959-61. [PMID: 23539413 DOI: 10.1007/s00405-013-2459-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 03/18/2013] [Indexed: 10/27/2022]
Abstract
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.
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Galluzzi F, Pignataro L, Gaini RM, Hartley B, Garavello W. Risk of recurrence in children operated for thyroglossal duct cysts: A systematic review. J Pediatr Surg 2013; 48:222-7. [PMID: 23331819 DOI: 10.1016/j.jpedsurg.2012.10.060] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 10/03/2012] [Accepted: 10/10/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the rate of recurrence following surgical treatment of thyroglossal duct cysts (TDGCs) in children. METHODS A search of electronic databases (Pubmed and MEDLINE) was performed in order to identify studies concerning surgical treatment of TGDCs in children published between 1980 and 2012. The following terms were used: "thyroglossal duct cysts", "recurrent", "recurrence", "children", "pediatric". RESULTS Sixteen articles were selected with the majority published during the last decade. The total number of included subjects was 1233. The mean (95% confidence interval (CI)) rate of recurrences was 10.7% (9.1%-12.6%). Eleven studies involving 751 subjects reported the frequency of recurrences separately for primary cases. The mean (95% CI) rate of recurrences was 10.8% (8.7%-13.3%). Five studies reported separately results of surgery for secondary cases. The mean (95% CI) rate of recurrences was 20.0% (12.2%-30.8%). Eight of the sixteen studies reported data on risk factors for recurrence. The use of the Sistrunk technique is a protective factor, whereas children who experienced repeated episodes of infection prior to surgery are exposed to a higher risk of recurrence. CONCLUSION Recurrences after surgery for TDGCs remain a clinically relevant issue. One of ten operated children experiences a recurrence. Available data support the use of the Sistrunk technique but further studies aimed at improving the clinical management of TDGCs are required.
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Affiliation(s)
- Francesca Galluzzi
- Department of Otorhinolaryngology, University of Milano-Bicocca, Monza, Italy
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