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

Retrospective comparison of endoscopic transoral and bilateral areolar approaches for thyroglossal cyst resection: a single-centre experience

PURPOSE

Our study aimed to compare the efficacy, safety, and clinical effect of the transoral approach and the bilateral areolar approach (BAA) for endoscopic thyroglossal duct cyst (TGDC) resection.

METHODS

In total, 42 patients who received an endoscopic TGDC resection between January 2019 and May 2022 via a transoral (n = 22) or bilateral areolar (n = 20) approach by a single surgeon were retrospectively enrolled. We collected and compared the following data: patients' demographic data, complication events, operative time, bleeding volume, drainage volume, 6-h postoperative pain scores, length of hospitalisation, resected TGDC size, and cosmetic satisfaction.

RESULTS

There were no cases of conversion to a transcervical approach in the two groups. No significant differences were found between the two groups in terms of age, sex, body mass index, complication, bleeding volume, 6-h postoperative pain scores, and TGDC size (all p > 0.05). However, the operative time and patients' cosmetic satisfaction were higher in the transoral group than in the BAA group (all p < 0.05). In addition, the drainage volume and length of hospitalisation in the transoral group were less than those in the BAA group (all p < 0.05).

CONCLUSIONS

Both the transoral approach and BAA are safe and reliable; however, the transoral approach is more complex than the BAA and offers better cosmetic satisfaction. Doctors should choose the appropriate surgical procedure based on the patient's condition and preferences.

Thyroglossal duct diseases: presentation and outcomes

OBJECTIVE

The incidence of thyroglossal duct diseases in the general population is about 7%. We aimed to demonstrate the clinical presentations and management of thyroglossal duct diseases.

METHODS

We conducted a retrospective review of all patients who underwent surgery for histopathologically confirmed thyroglossal duct cyst, sinus, or fistula at a single center.

RESULTS

A total of 151 cases were included in this study. There were more female patients (87, 58%) than male patients (64, 42%). The patients' ages ranged from 1 to 63 years old. The most prevalent complaint was painless upper midline neck swelling (93.3%). Most cases were diagnosed as thyroglossal duct cysts (137, 90.7%). Six cases (4%) were associated with carcinoma. All the cases were managed using the modified Sistrunk procedure. There were no procedure-related complications, and five cases of recurrence.

CONCLUSIONS

Although thyroglossal duct cyst is the most common neck anomaly in children, it may also present with various characteristics later in life. This condition can be managed successfully without complications and with a low recurrence rate.

Modified Sistrunk procedure in a pediatric population: Infected thyroglossal duct cysts as a risk factor for recurrence and review of the literature

AIM

To analyze the rate of recurrence and possible risk factors after surgical treatment in pediatric patients with thyroglossal ductus cyst (TGDC), who underwent the Modified Sistrunk Procedure (MSP).

DESIGN

Retrospective study.

INSTITUTION

The pediatric otorhinolaryngology clinic of a university.

MATERIALS AND METHODS

The study included a total of 251 pediatric patients aged between 2 and 17 years, whose histopathological diagnosis was confirmed and who underwent MSP due to TGDC over a period of 10 years from January 2009 to December 2019. The chi-square test was used to determine the relationship between the independent variables and the dependent variables. Parameters used in the study: The parameters were age, gender, the history of infected TGDC before surgery (cellulitis, abscess), incision and drainage in patients with abscess, number of cysts detected in ultrasonographic imaging, postoperative histopathology, and the number of recurrences.

RESULTS

The study included a total of 251 pediatric patients. The mean age of the children was 6.2 years (2-17 years), the mean follow-up period was 4.8 years (2-6 years), and 38 (15.13%) recurrences were observed after 251 MSP applications. Five risk factors were found to be statistically significant in terms of recurrence rates (p<0.05). These risk factors were surgery during the school period (6-10 years), history of infected TGDC, abscess formation, incision/drainage before MSP, and multicystic cyst in ultrasonographic evaluation.

CONCLUSION

The main determinant for the five significant risk factors among the causes of MSP recurrence is a history of infected TGDC before surgery. When there is no history of TGDC infection in pediatric patients before surgery, surgery should be planned under appropriate conditions before infection occurs. The risk of infected TGDC, cellulitis, and abscess formation increases at school age in particular due to frequent upper respiratory tract infections. When there is a cyst infection, antibiotic treatment should be applied, and incision and drainage should be avoided as much as possible in the presence of an abscess.

Endoscopically-Assisted Scar-Free Midline Neck Mass Excision

Traditional open surgery is indicated for the treatment of selected tumor subsites in the head and neck. However, it can cause major cosmetic problems and functional pathologies. The endoscopically-assisted transoral approach is increasingly preferred in some surgical fields due to its superior cosmetic and functional outcomes. Nonetheless, endoscopically-assisted transoral approach is not yet standard in the head and neck due to their anatomical complexity. The transoral surgical approach has been used for head and neck masses since the 1960s, and its application continues to evolve with changing disease conditions and recent innovations in surgical instruments. The potential for wide application of transoral surgery continues to be investigated, with a focus on minimizing occurrence of the complications. This review presents details of the surgical procedure and postoperative clinical outcomes, as well as endoscopically-assisted scar-free techniques for the resection of midline neck masses.

Management of Thyroglossal Cyst in Adults: A Single-Institution Experience

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.

Current trends and 30-day surgical outcomes for thyroglossal duct cyst excision in children

OBJECTIVE

Identify current trends, adverse events, and clinical predictors in children treated with thyroglossal duct cyst surgery.

METHODS

Cross-sectional analysis using American College of Surgeons (ACS) National Surgical Quality Improvement Program® (ACS NSQIP® - pediatric), years 2012-2016. Patients were identified using CPT codes: 60280 - excision of thyroglossal duct cyst or sinus and 60281 - excision of thyroglossal duct cyst or sinus, recurrent.

RESULTS

1532 (333 inpatient and 1199 outpatient) total cases were identified. Median age was 5.16 years interquartile range [IQR] (2.87, 8.35 years). No mortalities, cases of sepsis or nerve injury were identified. Adverse event rate was 4.4% (68/1532). Inpatient cases were associated with higher rates of adverse events (p = 0.006). Adverse events mostly consistent of wound infections, unplanned reoperations and readmissions, 2.6%, 2.2% and 2.0%, respectively. The most common unplanned reoperation was hematoma, seroma, or fluid drainage (0.59%). Median length of stay was 1 day, IQR (0, 1). An adjusted, multivariable logistic regression model revealed that the odds of adverse event rates for inpatient status were 101% higher than outpatients (odd ratio [OR] = 2.01; 95% CI = 1.20, 3.37; p = 0.008).

CONCLUSIONS

The most common adverse events were unplanned reoperations and readmissions. Outpatient surgery was most common and surgery for recurrent thyroglossal duct cysts was rare. Children selected for outpatient thyroglossal duct cyst surgery tended to be healthier and less medically complicated and may contribute to our observation of lower rates of adverse events compared to inpatients.

No-Scar Transoral Thyroglossal Duct Cyst Excision in Children

BACKGROUND

No-scar transoral thyroglossal duct cyst (TGDC) excision is a newly developed treatment for TGDC, but limited information is available regarding the clinical outcomes in children. The aim of this study was to evaluate the safety, efficacy, and effects of transoral TGDC excision in children.

METHODS

Forty-four children <10 years of age received operative treatment for TGDC from January 2013 to December 2014, and follow-up was performed over 24 months. Clinicopathologic, surgical, and follow-up data were collected and analyzed. The primary outcome variable was feasibility of the procedure, and the secondary outcome was patient's cosmetic satisfaction after each operation.

RESULTS

Twenty-one patients underwent transoral TGDC excision, and 21 patients underwent conventional excision. No significant differences were observed between the two groups in terms of the overall patient and operation factors. However, the rate of identifying the thyroglossal duct during transoral excision was superior to that during conventional excision (p < 0.05), and cosmetic satisfaction was much better in the transoral TGDC excision group (p < 0.001).

CONCLUSION

No-scar transoral TGDC excision in children is a potentially safe and effective methodology that can achieve easy removal of the thyroglossal duct and excellent cosmetic outcomes.

Midline cervical swellings: What a paediatrician needs to know

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.

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.

Modified Sistrunk operation: New concept for management of thyroglossal duct cyst

OBJECTIVE

To describe a method of hyoid cartilage division during Sistrunk operation for management of thyroglossal duct cyst (TGDC) and compare postoperative outcomes with those of conventional hyoid bone cutting.

METHODS

Fifty-nine patients who received operative treatment for TGDC from January 2005 to July 2013 were enrolled. The degree of fusion in the cartilaginous portion of the hyoid was evaluated by preoperative neck computed tomography and classified into (1) non-fusion, (2) partial fusion, and (3) complete fusion. Techniques of hyoid management, division of the cartilaginous portion of the hyoid or conventional hyoid bone cutting, during Sistrunk operation were analyzed according to the fusion classification.

RESULTS

Of the 59 patients, 27 were pediatric patients and 32 were adults. In 32 adults undergoing TGDC, there were 13 cases (41%) of complete hyoid fusion and 7 (22%) of non-fusion. A total of 20 adult patients (63%) were treated with the cartilage division. Among the pediatric patients, 96% of cases were classified as non-fusion of the hyoid, and all of these were treated with the cartilage division. Patients who were treated with the cartilage division showed better postoperative results. However, there were no statistical differences.

CONCLUSIONS

Our cartilage division technique at Sistrunk operation for TGDC is feasible and comparable to conventional hyoid cutting with regard to postoperative results.

Surgical management outcomes of recurrent thyroglossal duct cyst in children--A systematic review

OBJECTIVES

Management of recurrent thyroglossal duct cysts (TGDC) remains a clinical challenge to otolaryngologists--head and neck surgeons. The purpose of this systematic review is to determine the best surgical management for recurrent TGDC.

METHODS

A comprehensive search for relevant articles was carried out on electronic databases named Ovid Medline, Ovid Medline in process and Other Non-Indexed Citations, Embase, Ovid OldMedline, and Ovid Medline Daily. Articles published in English until 2014 were eligible for review. Using predefined inclusion criteria, published articles on surgical outcomes in the management of recurrent thyroglossal duct cyst, were selected, reviewed, and their findings synthesized.

RESULTS

Nine studies met the inclusion criteria for this systematic review comprising a total of 66 patients who underwent 114 secondary surgeries. Better outcomes were observed with en bloc neck dissection vs. a revision Sistrunk with a recurrence rate of 20% vs. 30.12% respectively. In addition two new surgical approaches, suture-guided transhyoid pharyngotomy and Koempel's suprahyoid technique reported 100% success rate.

CONCLUSION

Recurrence after primary surgical management remains a clinical challenge. We highlight the outcomes of the 4 main surgical techniques reported in the literature, repeat Sistrunk procedure, en bloc neck dissection, suture-guided transhyoid pharyngotomy, and Koempel's suprahyoid technique. Although this review reports a 100% success rate with the 2 latter techniques, further prospective studies and additional experience with these same techniques by other surgeons/institutions with or without a randomized trial could provide additional confirmation of improved outcomes using these specific surgical procedures.

Clinical presentation and treatment outcomes of thyroglossal duct cysts: a systematic review

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.