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

Pediatric thyroglossal duct cyst excision: A NSQIP-P analysis of 30-day complications

OBJECTIVE

Identify and compare clinical risk factors, perioperative sequelae, and surgical complications of infants age 2 or younger to children above age 2 undergoing thyroglossal duct cyst (TGDC) excision.

METHODS

Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement-Pediatric Database (2014-2018). Study population includes pediatric patients (≤18 years) who underwent excision of TGDC. Infants aged 2 years or younger were compared to children older than 2 years.

RESULTS

A total of 3052 cases were identified. There were 375 infants with an age of 2 years or younger and 2977 children who were older than 2 years. Mean age at time of surgery was 6.3 years, with a female-to-male ratio of 1:1.1. Following hospital discharge, there were 70 related readmissions and 3 related reoperations. There was no statistically significant gender (p = .270) or ethnic (p = .122) differences between groups. Additionally, a history of prematurity (p = .759) and postoperative admission status (ie, inpatient versus outpatient, p = .697) were not statistically significantly different between groups. Lastly, general complication rates between age groups including Clostridium difficile colitis, occurrences of bleeding and blood transfusion, surgical site infections, related readmission, and reoperation were not statistically significantly different.

CONCLUSION

TGDC excision was not shown to be associated with increased risk when performed in infants age 2 or younger compared to children older than age 2.

Why Central Neck Dissection Works (and Fails) for Recurrent Thyroglossal Duct Remnants

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.