Thyroglossal duct remnants in infants and children: reevaluation of histopathology and methods for resection

Does thyroglossal duct arborization play a role in the post-surgical outcome of Sistrunk procedure in children?

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.

Sistrunk vs modified Sistrunk procedures: Does procedure type matter?

BACKGROUND

Thyroglossal Duct Cyst (TDC) is the most common congenital neck mass in children and is surgically managed with a Sistrunk procedure. Some surgeons perform a modified Sistrunk (mSis), involving the dissection of the fistula beyond the hyoid bone without coring out the foramen cecum at the base of the tongue. We aim to evaluate surgical outcomes of children undergoing Sistrunk (Sis) or modified Sistrunk (mSis) procedures for TDC at an academic pediatric institution.

MATERIALS AND METHODS

We conducted a retrospective chart review of the Children's National Medical Center database from 2004 to 2014. Basic demographic information, preoperative characteristics, postoperative complications, and recurrence were extracted for children diagnosed with TDC. We estimated descriptive statistics using Kruskal-Wallis tests and Pearson's chi-square for continuous and categorical values.

RESULTS

157 patients that underwent TDC excision were identified. Sistrunk (Sis) was performed in 52 cases (33%) and modified Sistrunk (mSis) performed in 105 (67%) cases. 84 (54%) were female and the mean age at surgery was 5.4 years (SD=4.5). Overall recurrence was detected in 8 cases (5.1%) and did not differ significantly by procedure type [2 (4%) in Sis and 6 (6%) in mSis, p = 0.616]. Post-operative complications did not differ significantly between Sis and mSis procedure: swelling [6 (12%) and 18 (17%), p = 0.481]; seroma [5 (10%) and 10 (10%), p = 1.00]; surgical site infection [3 (6%) and 8 (8%), p = 0.752]; or post-excision incision and drainage [3 (6%) and 9 (9%), p = 0.752] (respectively).

CONCLUSIONS

Our findings reveal no statistical difference in recurrence rates between Sis and mSis with no risk factors for recurrence identified. Furthermore, there was no difference in post-operative complications between the groups. Both surgical procedures were associated with few complications and low recurrence.

Wide anterior neck dissection for management of recurrent thyroglossal duct cysts in adults

OBJECTIVE

Thyroglossal duct cyst recurrence following resection is attributed to anatomical variability and residual thyroglossal ducts. In adults, thyroglossal duct cyst recurrence is extremely rare and a surgical solution is yet to be well explored. This paper describes our approach to the management of recurrent thyroglossal duct cysts and sinuses in adults using a wide anterior neck dissection.

METHOD

A retrospective review was performed to identify adults who underwent a wide anterior neck dissection for recurrent thyroglossal duct cyst management between 1 January 2009 and 1 January 2015.

RESULTS

Six males and one female were included in the series (mean age, 26.4 ± 10.9 years). Recurrence occurred at a mean of 18 ± 9.8 months following primary surgical management (3 patients underwent cystectomy and 4 had a Sistrunk procedure). All patients subsequently underwent wide anterior neck dissection; there was no further recurrence over the 12-month average follow-up period.

CONCLUSION

This paper describes a wide anterior neck dissection technique for the management of recurrent thyroglossal duct cysts or sinuses in adults; this approach addresses the variable anatomy of the thyroglossal duct and is associated with minimal morbidity.

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

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

Recurrent Thyroglossal Duct Cysts: A 23-Year Experience and a New Method for Management

Objectives:

We present an experience in the management of primary and recurrent thyroglossal duct cysts (TGDCs) and describe a novel method for recurrent TGDC removal.

Methods:

We performed a retrospective review of TGDC surgery at Children's Hospital in Seattle from 1980 to 2003. The surgical techniques for primary and recurrent TGDCs and the factors associated with TGDC recurrence were evaluated and analyzed.

Results:

During the study period, 231 patients underwent 296 TGDC surgeries. Thirty-four of the 231 patients (15%) underwent a total of 88 procedures for recurrent TGDCs. Successful procedures used for secondary TGDC management included central neck dissection with directed base of tongue (BOT) excision in 6 of 9 patients (67%), secondary Sistrunk operation with limited BOT resection in 12 of 27 patients (44%), revision Sistrunk operation with BOT dissection in 7 of 11 patients (64%), and suture-guided transhyoid pharyngotomy in 8 of 8 patients (100%). Ten of the 231 patients (4%) had initial TGDC incision and drainage and then underwent a total of 21 procedures, excluding the incision and drainage. The factors associated with TGDC recurrence were inaccurate initial diagnosis (17 of 34 or 50%), infection (5 of 34 or 15%), unusual TGDC presentation (5 of 34 or 15%), and lack of BOT musculature removal (7 of 34 or 20%). The level of surgeon training affected the surgical outcome.

Conclusions:

Successful TGDC treatment requires consideration of factors associated with recurrence. Recurrent TGDCs can be treated by several methods, including suture-guided transhyoid pharyngotomy.

A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts

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 %).

Thyroglossal duct cyst excision with hyoid bone preservation

The objective of this study is to assess complete removal of the thyroglossal duct cyst (TGDC) and its tract(s) to the base of the tongue with sparing of the hyoid bone. This is a prospective cohort study. Tertiary hospital (Zagazig university hospital). This prospective study was carried out on 21 patients who had been diagnosed preoperatively as TGDC or fistula. All patients were managed by dissection and removal of the TGDC and its tract(s) to the base of the tongue with sparing of the hyoid bone. The study was conducted on 12 males (57.14 %) and 9 females (42.85 %) with mean age 6.8 years (4-20 years). After histopathological examination; 16 patients (9 male and 7 female) were proved to have TGDC and 5 patients (3 male and 2 female) were proved to have dermoid cyst. The hyoid bone could be preserved in all cases except in two cases for whom the middle third of the hyoid bone was removed with the specimen. Multiple tracts were found in three cases and could be identified and dissected successfully with sparing of the hyoid bone. Identification, dissection, and complete excision of the TGDC with its attaching tract(s) could be performed without hyoid bone resection with no recurrence and minimal minor complication. The impacts of this hyoid bone preservation versus removal on the pattern of swallowing and retroglossal space need to be studied.

Thyroglossal duct remnant surgery: a reliable, reproducible approach to the suprahyoid region

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.

"Extended" Sistrunk procedure in the treatment of recurrent thyroglossal duct cysts: a 10-year experience

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Thyroglossal duct cysts: 20 years' experience (1992-2011)

The objective of the present study is to report on the clinical course and management of thyroglossal duct cysts. Retrospective review of all patients who underwent surgery for thyroglossal duct cysts between 2000 and 2013 at a tertiary referral center was carried out. The operations were performed using a modification of the Sistrunk operation: transcervical cystectomy, partial dissection of the hyoid bone, and dissection of all tracts identified during surgery. A total of 352 patients (176 men, 176 women) underwent surgery for a cyst (n = 282) or discharging sinus (n = 70). The mean age for the incidence of cysts was 26 years. Four of the patients (1.4 %) had a papillary thyroid carcinoma in the epithelium of the cyst. The follow-up period ranged from 7 months to 10 years. The overall recurrence rate was 4.5 %. Resection is often regarded as an elective surgical procedure in patients with thyroglossal duct cysts, but surgery should always be considered. Papillary thyroid carcinoma in the epithelium of the cyst is a rare but possible differential diagnosis. Dissection of all tracts found is recommended and partial dissection of the hyoid bone is mandatory. Dissection of the foramen cecum is not imperative. The recurrence rates with this approach are comparable to more extensive methods such as those described by Sistrunk.

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

BACKGROUND

Thyroglossal duct cysts (TGDCs) are the most common form of congenital neck cyst, accounting for up to 70% of such lesions. There has been no consensus on which factors predict outcome of thyroglossal duct cyst excision. The objective of the current study is to evaluate the relevance of symptomatology and age at presentation with outcome of TGDCs.

METHODS

Retrospective review of patients with TGDC at a tertiary care children's hospital. Data collected included patient's age, gender, clinical presentation, presence or absence of preoperative infection, imaging modality, type of procedure performed, size and location of the lesion, postoperative infection, complications, and recurrence of disease.

RESULTS

Twenty-nine patients were identified (59% female, 41% male). Age of presentation was bimodal and ranged from 18 months to 14 years. The most common presenting symptom was the presence of an asymptomatic midline neck mass (76%). A history of preoperative TGDC infection was present in 22% of patients </=2 years of age and in 43% of patients >/=5 years of age. Recurrence rate after the Sistrunk procedure was 3.4%.

CONCLUSIONS

The finding of a midline neck mass is the most common presentation of TGDCs in toddlers, whereas infection is the most common presenting symptoms in school-aged children. The incidence of preoperative infection was 41% in our series, much higher than previously reported. Independent of presenting age and symptomatology, recurrence of TGDC remains low when the Sistrunk procedure is employed.

Management of incidental thyroglossal duct cysts during laryngotracheal reconstruction

Thyroglossal duct cysts originate from trapped elements of the thyroglossal duct tract during embryological descent of the thyroid gland. The incidental finding of a thyroglossal duct cyst during cervical surgery has not been described previously. We present four cases of small asymptomatic thyroglossal duct cysts discovered as an incidental finding during laryngotracheal reconstruction. In each case, the cyst was removed using a Sistrunk procedure. In all four cases the patient was successfully decannulated, and there were no cases of cyst recurrence. We also consider the implications that these four cases may have on the perceived incidence of the thyroglossal duct cysts and their management.

Imaging for thyroglossal duct cyst: the bare essentials

Thyroglossal duct cyst is the most common congenital cyst in the head and neck, and imaging features have been well documented in the literature. However, there are several practical important points to bear in mind during preoperative imaging, which are often overlooked. This review aims to summarize the imaging findings and emphasize important points for trainees and radiologists, particularly those who may encounter this lesion infrequently.

Core excision of the foramen cecum for recurrent thyroglossal duct cyst after Sistrunk operation

The recurrence rate for thyroglossal duct cysts after a Sistrunk operation is 5% compared with 20% if the hyoid cartilage is not removed. However, few guidelines exist when a lesion recurs after an adequate Sistrunk operation. A 2-year-old boy was referred for recurrent thyroglossal duct cyst after complete and adequate resection. Reexploration of the wound and wider excision of the midline cervical tissues failed to treat the problem. Using a combined transoral/cervical approach, a core of tongue around the foramen cecum was removed. A cystic structure was found at pathologic examination. The child remains asymptomatic 24 months later. If thyroglossal duct cysts recur despite an adequate Sistrunk operation, an intralingual remnant should be suspected. Transoral excision of tongue tissue around the foramen cecum may offer a cure.

Histological characterization of the thyroglossal tract: implications for surgical management

OBJECTIVES

In the current report, we characterized the relationship between the central hyoid bone and the thyroglossal tract and determined the prevalence of ectopic thyroid follicles in the adjacent soft tissues.

STUDY DESIGN

Retrospective pathological analysis.

METHODS

The resected specimens from 104 patients who underwent a modified Sistrunk procedure with wide-field dissection were retrospectively analyzed. Under light microscopy, serial sections were examined to determine whether the thyroglossal tract passed anterior to, posterior to, or within the hyoid bone. Specimens were also examined for the presence of thyroid follicles in the periductal and pericystic soft tissues.

RESULTS

In 50 cases (48%), the tract position in relation to the hyoid bone could not be identified secondary to extensive arborization, marked inflammation, specimen fragmentation or a combination of these. Thyroid follicles were observed in 9 (18%) of these specimens. In the remaining 54 cases (52%) the tract was located anterior to the central arch of the hyoid bone in 39 (72%) and posterior to it in 15 (28%). Thyroid tissue was observed in 46% of specimens (P =.004), regardless of whether the tract was anterior or posterior.

CONCLUSIONS

These results demonstrate that tract position often cannot be defined, but when a portion is dominant, it is likely to be anterior to the hyoid bone. Ectopic thyroid tissue can be found in almost 50% of specimens when the tract position is identifiable. With appropriate surgical management, a recurrence rate of less than 4% can be expected, despite the presence of ductule multiplicity, marked inflammation, tract position posterior to the hyoid bone, and ectopic thyroid follicles.

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

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

Morphology of the human thyroglossal tract: a histologic and macroscopic study in infants and children

The anatomic development of thyroglossal tract remnants is not understood at present. For analysis of morphology and growth patterns of thyroglossal tract remnants, we used histologic whole organ serial sections to determine developmental changes through the first years of life. Larynges of 58 infants and children ages 1 month to 13 years were obtained in whole organ serial step-sections in an axial plane. The slides were stained with hematoxylin and eosin, Alcian blue, and periodic acid-Schiff stains. Altogether, 3,247 histologic slices were examined. The resulting data were then correlated with the age and sex of the specimens. We found, in 24 cases (41.3%), remnants of the thyroglossal tract or ectopic thyroid tissue. In 4 specimens (16.6%), a complete thyroglossal tract could be observed that presented a ventral path in relation to the hyoid bone with no contact with the perichondrium of the cartilage. Hormonal activity of ectopic thyroid tissue was proven in 20 cases (34.5%). Thyroid follicles were located in 2 cases (3.5%) in the hyoid bone. The thyroglossal ducts revealed a modest tendency for a left-sided pathway, whereas thyroid follicles were located more on the right paramedian side. Morphometric data on the development and structure of the thyroglossal tract and the thyroid follicles during infancy and childhood are presented. The study provides quantitative data of clinical interest that elucidate the anatomy of thyroglossal tract remnants. In addition, our investigation supports Sistrunk's operative approach for avoiding recurrences in the treatment of thyroglossal duct cysts.

Clinical results of the shallow core-out procedure in thyroglossal duct cyst operation

PURPOSE

This procedure for thyroglossal duct cyst operation based on pathological studies was first published in the Journal of Pediatric Surgery in 1992. This procedure is similar to Sistrunk's operation except that the core depth of the tongue excision is more shallow (about 5 mm in young children). The purpose of this report is to report and evaluate the clinical results of this operation compared with our earlier operative results.

METHODS

Eighty-three patients underwent surgery for thyroglossal duct cyst from 1970 to 1997. They were divided into 3 groups. Group I consisted of 31 patients undergoing Schlange's operation (1970 to 1988). Group II were 18 patients undergoing Sistrunk's operation (1989 to 1990). Group III consisted of 34 patients operated on with the authors' procedure (1991 through 1997). The 3 groups are compared for recurrence rate.

RESULTS

Recurrence in group I was 6 of 31 (19.3%), 1 of 18 (5.6%) in group II, and 1 of 34 (2.9%) in group III. The recurrence rate showed a statistically significant difference only between group I and III (P = .033).

CONCLUSION

The recurrence rate with our procedure was not higher than that of Sistrunk's operation but was significantly lower than for Schlange's operation.

Central neck dissection for the treatment of recurrent thyroglossal duct cysts in childhood

OBJECTIVE

The recurrence rate of thyroglossal duct cysts removed by the classic Sistrunk procedure exceeds 4%, even in skilled hands. Simple reexcision fails in 33% of these patients. Recent pathology literature suggests that the tracts of thyroglossal duct cysts may arborize, arguing for a wide-field approach to recurrent lesions. We describe the anatomic rationale and technique of an en bloc central neck dissection in children, on the basis of cadaver dissections and histopathologic review of recurrent thyroglossal duct cyst specimens.

METHODS

We reviewed the medical records of all the children undergoing surgery for thyroglossal duct cysts and fistulas during the years 1990 to 1998 by the senior author. En bloc central neck dissections were performed on several cadaver specimens to further delineate the anatomic rationale for this procedure.

RESULTS

We have performed an en bloc central neck dissection in 7 children, 5 with recurrent or multiply recurrent thyroglossal duct cysts. None has had a recurrence after follow-up of 9 months to 6 years. All have acceptable functional and cosmetic results.

CONCLUSION

An en bloc central neck dissection is a logical and effective surgical technique for the removal of recurrent or multiply recurrent thyroglossal duct cysts.

MR imaging of thyroglossal duct cysts in adults

AIM

To describe the magnetic resonance (MR) features of thyroglossal duct cysts (TDC) in adults.

PATIENTS AND METHODS

Sixteen patients with TDC underwent MR imaging to obtain T1- and T2-weighted images and T2-weighted fat saturation images. In addition, contrast enhanced images were obtained in five patients.

RESULTS

The signal intensity of TDC was of that of a simple cyst in seven (44%) patients, yielding high signal intensity on T2- and low signal intensity on T1-weighted images. In nine (56%), the signal intensity was either intermediate or high on T1-weighted images, the T2 signal intensity in these cases being high (7), intermediate (1) or low (1). Enhancement of the wall of the cyst was present in three of five (60%) patients. All 16 TDC were located at or just to one side of the midline and 12 were embedded in the strap muscles. All TDC were infrahyoid in location but 11 also extended superiorly to be directly related to the hyoid. At the hyoid the cystic component was immediately posterior (6) anterior (3) or anterior and posterior (2) to the bone. Intralaryngeal extension was present in eight (50%) patients. A suprahyoid tract was identified in three patients. The thyroid gland was in a normal location in all patients.

CONCLUSION

Thyroglossal duct cysts are most commonly of high T1 signal intensity consistent with high protein content. The tract leading to the base of the tongue is infrequently seen, the diagnosis being determined by the intimate relationship to the hyoid and strap muscles. Intralaryngeal extension in adult patients with TDC is more frequent than reported previously.

Thyroglossal Duct Cyst: The New York Eye and Ear Infirmary Experience and a Literature Review

Thyroglossal duct cysts often present in childhood but can also afflict the adult population. In 1920, Sistrunk described surgical management and advocated the removal of the central portion of the hyoid bone, following the cyst tract to the base of the tongue. This surgical technique has not changed since its description 60 years ago. In this paper, a retrospective review of 70 thyroglossal duct cyst excisions performed at the New York Eye and Ear Infirmary from 1988 through 1996 is presented. The patient population consisted of 43 females (61 %) and 27 males (39%). The average age at presentation was 21.5 years, with a range of 18 months to 64 years. The most frequent presenting symptom was a painless midline neck mass. Computed tomography (CT) was the most frequent imaging study performed. Sixty-four patients underwent a Sistrunk procedure while five patients had excision alone. One patient was diagnosed but lost to follow-up. All five patients who underwent simple cystectomy required a second procedure. One patient who underwent the Sistrunk operation required revision. Nine patients had postoperative complications, with recurrence being the most common. We present our experience over an eight-year period.

Recurrent thyroglossal duct cysts: a clinical and pathologic analysis

OBJECTIVE

To analyze, in detail, the clinical and pathological findings in a patient population that had undergone previous Sistrunk procedures for the removal of thyroglossal duct cysts, in order to identify any possible factors that could be related to recurrence after 'definitive' surgery.

SETTING

A large pediatric tertiary care center.

METHODS

A retrospective chart review was performed to include all patients treated at a single center for thyroglossal duct cysts with a Sistrunk procedure, between 1978 and 1992 inclusive.

RESULTS

A total of 108 consecutive patients were analyzed. We noted that the presence of recent preoperative infection of the cyst was the only statistically significant (P < 0.05) clinical difference noted between the successful and the unsuccessful surgical groups. However, pathological analysis revealed that there was a substantially greater number of multiple thyroglossal duct tracts (P < 0.05) noted in the group that failed a Sistrunk procedure.

CONCLUSIONS

We feel that multiple thyroglossal tracts may play an etiologic role in some recurrent cysts. Thus, a wide conservative excision, including the middle two thirds of the hyoid bone, is necessary in order to include any multiple tracts in the resection.

Thyroglossal Duct Cyst Causing Airway Obstruction in an Adult

Thyroglossal duct cysts, though not uncommon, rarely present with evidence of laryngeal compromise. The case presented is one of the very few cases with documented laryngeal invasion reported in the English language. Of clinical significance is the patient's presentation with laryngeal symptoms of choking and dysphonia in the presence of a small anterior cervical mass. While the thyroglossal duct cyst usually presents as an asymptomatic anterior neck mass, this case illustrates the importance of considering a thyroglossal duct cyst in any patient with airway compromise in the absence of a neck mass.

Unusual inflamed thyroglossal cyst

The authors report a case of an unusual inflammatory reaction in a thyroglossal cyst. It consisted of broad papillary intraluminal projections covered by histiocytes and occasional multinucleate giant cells. This benign process should not be confused with a true papillary neoplasm, a rare complication of a thyroglossal cyst.

Lingual thyroglossal duct cyst presenting in infancy

Lingual thyroglossal duct cysts are a rare form of thyroglossal cysts. We present two infants, 10 and 12 weeks of age, with midline intraoral cystic swellings stretching from the base of the tongue to the thyroid cartilage. Complete excision of the cysts by Sistrunk's procedure were carried out. Both infants are well on follow-up, at 6 months postoperatively. Their unique presentation with regard to age, location, and symptomatology is discussed. Lingual thyroglossal duct cysts large enough to cause dysphagia, stridor, respiratory distress, and failure to thrive in infants have not been previously reported in the literature.

An unusual case of intermittent upper airway obstruction

Thyroglossal duct cyst is an unusual cause of intermittent upper airway obstruction and rarely produces obstructive symptoms in adults. Previous reports discuss airway obstruction in small children and infants and point out the complications of such cysts, including thyroid carcinoma, adenoma, thyroiditis, and thyrotoxicosis, as well as inflammation and infection. Diagnosis should be considered in all cases of midline neck masses and is usually aided by diagnostic imaging. Treatment may involve airway maintenance and surgical excision of the cyst and its entire tract.