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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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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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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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Arda MS, Ortega G, Layman IB, Khubchandani NA, Pichardo MS, Petrosyan M, Preciado DA, Qureshi FG. Sistrunk vs modified Sistrunk procedures: Does procedure type matter? J Pediatr Surg 2021; 56:2381-2384. [PMID: 33926727 DOI: 10.1016/j.jpedsurg.2021.03.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/04/2021] [Accepted: 03/15/2021] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Mehmet S Arda
- Department of Pediatric Surgery, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Ilan B Layman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA; Howard University College of Medicine, Washington, DC USA
| | - Nisha A Khubchandani
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA; Albany Medical College, Albany, NY USA
| | - Margaret S Pichardo
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA; Howard University College of Medicine, Washington, DC USA; Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT USA
| | - Mikael Petrosyan
- General and Thoracic Surgery, Department of Surgery, Children's National Medical Center, Washington, DC USA
| | - Diego A Preciado
- Division of Pediatric Otolaryngology, Department of Surgery, Children's National Medical Center, Washington, DC USA
| | - Faisal G Qureshi
- Division of Pediatric Surgery, Department of Surgery, Children's Medical Center, University of Texas Southwestern, Dallas TX USA.
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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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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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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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Isaacson G, Kaplon A, Tint D. Why Central Neck Dissection Works (and Fails) for Recurrent Thyroglossal Duct Remnants. Ann Otol Rhinol Laryngol 2019; 128:1041-1047. [PMID: 31271039 DOI: 10.1177/0003489419859033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review the patient characteristics and outcomes for children and undergoing central neck dissection for control of recurrent thyroglossal duct cysts and fistula following prior Sistrunk procedures and children requiring surgery for refractory infection. METHODS We performed a computerized review of all children who were evaluated for thyroglossal duct cysts during the years 1999-2018 by a single surgeon operating at an urban children's hospital and an outpatient surgical center. Those requiring a central neck dissection for control of recurrent disease or intractable infection were identified. Age at time of surgery, sex, surgical procedure, and postoperative complications were recorded. These data were combined with similar data from a published report by the same surgeon in the years 1990-1998 to complete a 28-year review. RESULTS 18 central neck dissections were performed including 13 for recurrent thyroglossal duct remnants after Sistrunk procedures and 5 primary surgeries for intractable infection. Ages ranged from 3 to 19 years (median = 10 years) and 13 of 18 were girls (72%). Four children had their first Sistrunk surgery performed by the senior author. Three children operated elsewhere had intact hyoid bones at the time of revision surgery, suggesting less-than-Sistrunk primary surgeries. Central neck dissection controlled disease in the lower neck in all cases. One child re-fistulized at the level of the hyoid. CONCLUSIONS Central neck dissection in combination with a Sistrunk-type dissection of the tongue base is effective in the control of recurrent infection following unsuccessful Sistrunk surgery and aids in dissection for children with intractable infection. Although this technique reliably controls infrahyoid disease and improves access to the hyoid and posterior hyoid space, it does nothing to address the difficulties of following the thyroglossal tract into the tongue base.
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Affiliation(s)
- Glenn Isaacson
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.,Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Adam Kaplon
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Derrick Tint
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.,Pittsburgh Ear Associates, PA, USA
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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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11
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The Central Neck Dissection or the Modified Sistrunk Procedure in the Treatment of the Thyroglossal Duct Cysts in Children: Our Experience. BIOMED RESEARCH INTERNATIONAL 2018. [PMID: 30018983 DOI: 10.1155/2018/8016957.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The aim of the study was to present the surgical techniques providing the lowest recurrence rate in treatment of the primary and recurrent thyroglossal duct cyst (TGDC) in children. Methods The study included 73 patients operated on because of TGDC in years 2011-2016. Ultrasound was performed in all patients preoperatively. In 8 patients with the recurrence of the disease, the CT or MR was carried out before the surgery. Children with the primary disease underwent the modified Sistrunk procedure. In the revision cases the central neck dissection was a method of choice. Results In 45 children, the modified Sistrunk procedure was performed and 28 underwent the central neck dissection. In 2 patients, hematoma occurred after the modified Sistrunk procedure with the need of the surgical revision in one. No complications were observed after the central neck dissection. Conclusions A modified Sistrunk procedure is method of choice in the treatment of the uncomplicated TGDC. In selected cases of the TGDC with a history of infected cyst or incision of an abscess or in revision cases the central neck dissection should be considered in order to avoid the risk of the further recurrences.
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The Central Neck Dissection or the Modified Sistrunk Procedure in the Treatment of the Thyroglossal Duct Cysts in Children: Our Experience. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8016957. [PMID: 30018983 PMCID: PMC6029493 DOI: 10.1155/2018/8016957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/16/2018] [Indexed: 11/17/2022]
Abstract
Background The aim of the study was to present the surgical techniques providing the lowest recurrence rate in treatment of the primary and recurrent thyroglossal duct cyst (TGDC) in children. Methods The study included 73 patients operated on because of TGDC in years 2011–2016. Ultrasound was performed in all patients preoperatively. In 8 patients with the recurrence of the disease, the CT or MR was carried out before the surgery. Children with the primary disease underwent the modified Sistrunk procedure. In the revision cases the central neck dissection was a method of choice. Results In 45 children, the modified Sistrunk procedure was performed and 28 underwent the central neck dissection. In 2 patients, hematoma occurred after the modified Sistrunk procedure with the need of the surgical revision in one. No complications were observed after the central neck dissection. Conclusions A modified Sistrunk procedure is method of choice in the treatment of the uncomplicated TGDC. In selected cases of the TGDC with a history of infected cyst or incision of an abscess or in revision cases the central neck dissection should be considered in order to avoid the risk of the further recurrences.
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13
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Bilateral areolar endoscopic Sistrunk operation: a novel technique for thyroglossal duct cyst surgery. Surg Endosc 2016; 31:1993-1998. [PMID: 27492432 DOI: 10.1007/s00464-016-5137-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/16/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sistrunk operation of the thyroglossal duct is a procedure for the removal of a cyst, the middle part of the hyoid bone and tract towards the foramen caecum. Unavoidably, this procedure results in a scar on the skin in the neck area. By performing a bilateral areolar endoscopic Sistrunk operation, this study is the first to develop a procedure that can solve the aesthetic problem. This operation results in both an excellent cosmetic result and the successful treatment of TGDC. METHODS A three-port technique was performed in this operation: 10-mm port for 30°, 10-mm laparoscope, 5-mm port for the instrument at the left circumareolar area and 5-mm port located at the right circumareolar area. Insufflation pressure of CO2 gas was set at 6 mm Hg. The surgical working space was located over the breast tissue and pectoralis muscles, towards the anterior neck to the hyoid bone. The steps employed for resection were similar to a conventional Sistrunk operation using standard laparoscopic instruments and hook scissors. RESULTS A series of 11 patients were successfully treated using this novel technique with neither conversion to open surgery nor surgical complications. Average operative time was 88.54 min (ranging from 60 to 130 min). Average blood loss was 35 mL. (ranging from 15 to 67 mL). Patients were discharged in an average of 2.36 days after the procedure (ranging from 2 to 3 days). CONCLUSION This novel technique for TGDC Sistrunk surgery using an areolar approach is feasible, safe and effective. The benefit of this technique is the cosmetic result, which leaves no scarring on the neck after wound healing and may provide a new method for optimal aesthetic results.
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Ibrahim FF, Alnoury MK, Varma N, Daniel SJ. Surgical management outcomes of recurrent thyroglossal duct cyst in children--A systematic review. Int J Pediatr Otorhinolaryngol 2015; 79:863-867. [PMID: 25890397 DOI: 10.1016/j.ijporl.2015.03.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/21/2015] [Accepted: 03/21/2015] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Farid F Ibrahim
- Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Mohammed K Alnoury
- Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Namrata Varma
- Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Sam J Daniel
- Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University, Montreal, QC, Canada.
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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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