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Ahn D, Kwak JH, Lee GJ, Sohn JH. Ultrasound-guided ethanol ablation versus the Sistrunk operation as a primary treatment for thyroglossal duct cysts. Ultrasonography 2024; 43:25-34. [PMID: 38087396 PMCID: PMC10766887 DOI: 10.14366/usg.23128] [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: 07/04/2023] [Revised: 08/19/2023] [Accepted: 09/02/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE This study compared ethanol ablation (EA) with the Sistrunk operation (SO) with regard to feasibility, treatment efficacy, and cost-effectiveness. The goal was to evaluate whether EA could replace SO as a primary treatment modality for thyroglossal duct cysts (TGDCs). METHODS This retrospective case-control study included patients with TGDCs who were treated with either EA or SO between 2016 and 2022. The primary outcome variables evaluated were treatment efficacy (as measured by the volume reduction rate [VRR] and treatment success rate), complications, and cost-effectiveness. RESULTS A total of 72 patients were enrolled, with 33 in the EA group and 39 in the SO group. The procedure or operation times for the EA and SO groups were 9 and 82 minutes, respectively (P<0.001). At the final follow-up appointment, the VRR was 94.1% for the EA group and 100.0% for the SO group (P<0.001). Treatment success was achieved for 32 patients (97.0%) in the EA group and for all 39 patients (100.0%) in the SO group (P=0.458). The overall complication rates were 0.0% and 17.9% in the EA and SO groups, respectively (P=0.013). The total costs, including all treatment procedures and follow-up ultrasound examinations, were $485 and $1,081.7 for the EA and SO groups, respectively (P<0.001). CONCLUSION EA demonstrates superiority over SO in terms of feasibility, safety, and costeffectiveness, while maintaining comparable treatment efficacy. Despite the need for multiple treatment sessions in approximately one-quarter of patients, EA can serve as a primary treatment modality for selected patients with TGDCs, supplanting SO.
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Affiliation(s)
- Dongbin Ahn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ji Hye Kwak
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Gil Joon Lee
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Ho Sohn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Ahn D, Kwak JH, Lee GJ, Sohn JH. Ultrasound-Guided Ethanol Ablation as a Primary Treatment for Thyroglossal Duct Cyst: Feasibility, Characteristics, and Outcomes. Otolaryngol Head Neck Surg 2023; 168:1381-1388. [PMID: 36939631 DOI: 10.1002/ohn.231] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/11/2022] [Accepted: 11/28/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To evaluate the feasibility, characteristics, and outcomes of ultrasound-guided ethanol ablation (US-EA) as a primary treatment for thyroglossal duct cysts (TGDCs). STUDY DESIGN Prospective case series. SETTING Single center study. METHODS The inclusion criteria were as follows: (i) patients with TGDC aged ≥18 years, (ii) benign TGDC in imaging and cytological examinations, and (iii) patients' need for nonsurgical scarless treatment. US-EA was used as the primary treatment strategy. The primary outcome variables were the volume reduction rate (VRR) and cosmetic score at the last follow-up. RESULTS We enrolled 28 patients with TGDC. The median TGDC volume at baseline was 6.7 mL. The median procedure time of the US-EA was 6.5 minutes. The median volumes of the cyst aspirate and injected ethanol were 4.0 and 2.0 mL, respectively. Overall, 18, 8, and 2 patients underwent 1, 2, and 3 treatment sessions, respectively. There were no complications. The median VRR was 96.2%, and the treatment success rate was 96.4%. The World Health Organization cosmetic score decreased from 4 (baseline) to 1 (after treatment) in all patients. The subjective grade for cosmetic satisfaction was satisfactory or highly satisfactory in all patients. The VRR, treatment success rate, and the number of treatment sessions did not differ as functions of the characteristics of the TGDC, including the initial volume, septation, debris, or viscosity of the cyst fluid. CONCLUSION US-EA was feasible, safe, and effective in patients with TGDC. Therefore, US-EA can be used as a primary treatment for TGDC, evading general anesthesia and surgical scar.
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Affiliation(s)
- Dongbin Ahn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ji Hye Kwak
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Gil Joon Lee
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Ho Sohn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Park SI, Baek JH, Chung SR, Choi YJ, Lee JH, Kim TY, Lee YM, Baek SM. Ethanol ablation for the treatment of thyroglossal duct cysts: follow-up results for longer than 2 years. Eur Radiol 2022; 32:3525-3531. [PMID: 34993573 DOI: 10.1007/s00330-021-08402-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the long-term efficacy and safety of ethanol ablation (EA) for the treatment of thyroglossal duct cysts (TGDCs). METHODS This retrospective study included 81 consecutive patients diagnosed with and treated for symptomatic TGDCs at two institutions between Jan 2008 and Oct 2018. Preprocedural evaluation included US assessment with calculation of the TGDC volume. EA was performed under US guidance using 99% ethanol. Post-treatment follow-up was scheduled within 3 months, 6 months, and then annually. Immediate success was defined as a volume reduction ratio (VRR; ratio of the volume difference after EA to the initial TGDC volume) > 50% within 3 months. Long-term success was defined as VRR > 50% or resolution or improvement of cosmetic problems and symptoms without recurrence at last follow-up. RESULTS Seventy-seven patients underwent EA, and outcomes were assessed in 68 patients with available follow-up data. The immediate success rate of the first EA was 81% (55/68), with a mean VRR within 3 months of 73% ± 31%. One patient (1.5%, 1/68) developed wound inflammation after the first EA. Forty-two patients were followed up for longer than 2 years. For the median follow-up of 69 months (range, 24-131 months), the long-term success rate was 83% (35/42), with a mean VRR at last follow-up of 81% ± 35%. No patients developed malignancy from the ablated TGDCs. CONCLUSIONS EA for treatment of TGDCs achieved acceptable rates of immediate and long-term efficacy with a low complication rate, and can be considered as a first-line treatment for the management of TGDCs. KEY POINTS • The immediate success rate of EA for the treatment of TGDCs was 81% (55/68), with a mean VRR within 3 months of 73% ± 31%. • For the median follow-up of 69 months (range, 24-131 months), the long-term success rate was 83% (35/42), with a mean VRR at last follow-up of 81% ± 35%. • No patients developed malignancy from the ablated TGDCs but one patient (1.5%, 1/68) developed wound inflammation after the first EA.
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Affiliation(s)
- Sang Ik Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-735, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-735, Korea.
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-735, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-735, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-735, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-735, Korea
| | - Yu-Mi Lee
- Division of Endocrine Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-735, Korea
| | - Seon Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Korea
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Lee E, Park I, Elzomor A, Li L, Lloyd A, Benito DA, Goodman JF, Thakkar PG, Joshi A. Efficacy of ethanol ablation as a treatment of benign head and neck cystic lesions. Am J Otolaryngol 2021; 42:103082. [PMID: 34029918 DOI: 10.1016/j.amjoto.2021.103082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of ethanol ablation in the treatment of benign head and neck cystic lesions. METHODS A total of 25 patients who received ethanol ablation (EA) of head and neck cystic lesions by an otolaryngologist at a single institution between October 2017 and October 2020 were identified. Patient demographics, clinical characteristics, treatment details, and treatment outcomes at follow up visits were obtained by retrospective review of electronic medical records. RESULTS 25 patients who underwent ethanol ablation of head and neck cystic lesions were included, with a mean age of 49.1 years old (Interquartile range (IQR),32.5-65.5 years) and 12 males (47.0%). The most common cysts treated with EA were thyroglossal duct cysts (n = 8, 32.0%) and lymphoepithelial parotid cysts (n = 7, 28.0%). The mean volume prior to treatment was 10.57 mL (IQR, 1.58-8.81 mL). Mean volume following EA was 1.30 mL (range, 0.10-0.97 mL) with 74.40% cyst reduction by volume (IQR, 48.56-96.29%) (p = 0.002). The mean time to the last follow-up was 5 months (range, 3-6 months). One patient received surgery despite treatment success to obtain a definitive diagnosis of the mass. No other patients received further surgical management. The treatment success of EA, as defined by >70% volume reduction or the resolution of symptoms, was 92.0%. All patients were satisfied with the outcome and had no reported complications. CONCLUSION EA is an effective and safe alternative to surgery for the treatment of head and neck cystic lesions that can be performed in an outpatient setting by an otolaryngologist.
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Chemical ablation using ethanol or OK-432 for the treatment of thyroglossal duct cysts: a systematic review and meta-analysis. Eur Radiol 2021; 31:9048-9056. [PMID: 34003346 DOI: 10.1007/s00330-021-08033-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/21/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To review the effectiveness and safety of chemical ablation using ethanol or OK-432 for the treatment of TGDCs (thyroglossal duct cysts). METHODS MEDLINE and EMBASE databases were searched up to May 29, 2020, to identify studies reporting the safety and efficacy of chemical ablation using ethanol or OK-432 for the treatment of TGDCs. The search query consisted of synonyms of thyroglossal duct cysts and ethanol or OK-432 ablation. The pooled success and complication rates were calculated using the inverse variance method to calculate weights, and pooled proportions were determined using the DerSimonian-Laird random-effects method. RESULTS Seven original articles including a total of 129 patients were included. The efficacy of chemical ablation was acceptable, with a pooled success rate of 70% (95% CI, 47-86%). The pooled success rate of ethanol ablation was superior to that of OK-432 ablation, although with equivocal statistical significance (84% vs. 51%, p = 0.055). Repeat ethanol ablation achieved a pooled success rate of 47% (95% CI, 24-71%). The chemical ablation procedures were safe, with a pooled major complication rate of 0.9% (95% CI, 0.1-5.8%). CONCLUSIONS Chemical ablation using ethanol or OK-432 for the treatment of TGDCs had acceptable success and low complication rates, and repeat treatment after initial failure was also feasible. In addition, it is an inexpensive and simple procedure and could therefore be considered a first-line treatment for TGDCs. KEY POINTS • The efficacy of chemical ablation using ethanol or OK-432 was acceptable, with a pooled success rate of 70% (95% CI, 47-86%). The pooled success rate of ethanol ablation was superior to that of OK-432 ablation, although with equivocal statistical significance (84% vs. 51%, p = 0.055). • Repeat ethanol ablation was also feasible, with a pooled success rate of 47% (95% CI, 24-71%). • The chemical ablation procedures were safe, with a pooled major complication rate of 0.9% (95% CI, 0.1-5.8%).
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Karatay E, Javadov M. The effectiveness of ethanol ablation in the treatment of thyroglossal duct cysts in adult cases and evaluation with cosmetic scoring. Jpn J Radiol 2021; 39:994-999. [PMID: 33993431 DOI: 10.1007/s11604-021-01135-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/11/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate thyroglossal duct cyst (TGDC) volumes before and after treatment with ultrasound (US) in patients who underwent ethanol ablation (EA). Besides, the usability of cosmetic scoring in TGDC cases was investigated by comparing cosmetic scores pre-treatment and after EA. MATERIALS AND METHODS 28 TGDC cases who had EA in one session and had complete US data and cosmetic scores were included in the study. US data including TGDC diameters and volumes obtained at the pre-treatment, 3rd, 6th, and 12th month after EA were noted, respectively. Cosmetic scoring was performed pre-treatment and after EA using the WHO grading system simultaneously with US. RESULTS At the 12th month after EA, there was 85.2% reduction in mean diameter and 95.1% reduction in mean volume in TGDC cases (p < 0.001). The mean cosmetic score pre-treatment was 2.7 ± 0.8 and the mean cosmetic score at the 12th month was 1 (p < 0.001). When the changes in TGDC volumes and cosmetic scoring after EA were compared according to gender and age, there was no statistically significant difference (p > 0.05). CONCLUSION The current study demonstrated that EA can be used safely to reduce TGDC sizes and is an alternative treatment option to surgery.
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Affiliation(s)
- Emrah Karatay
- Department of Radiology, Istanbul Kartal Dr. Lutfi Kirdar City Hospital, D-100 Güney Yanyol No:47 Cevizli Mevkii Kartal, 34865, Istanbul, Turkey.
| | - Mirkhalig Javadov
- Department of General Surgery, Yeditepe University Faculty Of Medicine, Istanbul, Turkey
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Kitazawa T, Shiba M, Nagaya H, Yuzuriha S. Cranial dermoid cyst with long-term development treated by ethanol sclerotherapy: a case report. Case Reports Plast Surg Hand Surg 2020; 7:130-133. [PMID: 33178882 PMCID: PMC7594762 DOI: 10.1080/23320885.2020.1835485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/08/2020] [Indexed: 12/02/2022]
Abstract
Here, we describe the case of an 80-year-old woman who presented with cranial dermoid cyst causing orbital disfigurement. The cyst was treated successfully with ethanol sclerotherapy and has shown no growth for 1 year.
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Affiliation(s)
- Takeshi Kitazawa
- Department of Plastic and Reconstructive Surgery, Matsunami General Hospital, Gifu, Japan
| | - Masato Shiba
- Department of Plastic and Reconstructive Surgery, Matsunami General Hospital, Gifu, Japan
| | - Hiroyuki Nagaya
- Department of Plastic and Reconstructive Surgery, Matsunami General Hospital, Gifu, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine and Graduate School of Medicine, Matsumoto, Japan
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Liao LJ, Wang CT, Huang TW, Cheng PW, Lo WC. Ultrasound-guided-fine-needle Aspiration Drainage and Percutaneous Ethanol Injection for Benign Neck Cysts. J Med Ultrasound 2020; 28:225-229. [PMID: 33659161 PMCID: PMC7869730 DOI: 10.4103/jmu.jmu_111_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/10/2020] [Accepted: 02/12/2020] [Indexed: 11/09/2022] Open
Abstract
Background: Ultrasound-guided-fine-needle aspiration drainage (US-FNAD) and US-percutaneous ethanol injection (US-PEI) have been widely used in the management of benign neck cysts. However, the long-term results of US-FNAD and US-PEI are not well elucidated. Methods: We retrospectively collated patients under neck US examinations from March 2007 to December 2017 and investigated the recurrence after US-FNAD and US-PEI. Univariate and multivariate Cox regression analyses were used to assess significant risk factors for recurrence after US-FNAD. Results: A total of 1075 patients were recruited, and their age was 50 ± 15 (mean ± standard deviation) years. A total of 862 patients had thyroid cysts, 118 patients had thyroglossal duct cysts (TGDC), twenty patients had branchial cleft cysts, 64 patients had parotid sialocysts, and 11 patients had plunging ranulas. Majority of the patients (97%, 1037/1075) reported significant symptom improvement immediately. However, 38% of the patients had recurrence with a median 3-year follow-up period. In a multivariate Cox regression analysis with adjustment for age and gender, plunging ranula (hazard ratio [HR]: 2.44, 95% confidence interval [CI]: 1.19–4.99) and lateral dimension size ≥ 0.8 cm (HR: 1.32, 95% CI: 1.04–1.67) after US-FNAD were independent risk factors for recurrence. There were 15 male and 19 female patients who received US-PEI therapy after repeated US-FNAD, of whom 23 patients had thyroid cysts, 6 had plunging ranulas, 4 had TGDC, and one had a branchial cleft cyst. The overall success rate was 94% (32/34), with a median follow-up period of 1.6 years. Two recurrent symptomatic patients had plunging ranulas. Some patients stated mild pain (21%, 7/34) and swelling sensation (26%, 9/34) after the injection. No major complications, such as vocal fold paresis or airway compression, were found. Conclusion: US-FNAD is an effective tool in the management of benign neck cysts with a 38% recurrence rate. Plunging ranulas have the highest rate of recurrence after FNAD. US-PEI is effective for most recurrent neck cysts after repeated US-FNAD.
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Affiliation(s)
- Li-Jen Liao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan.,Biomedical Engineering Office, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Biomedical Engineering Office, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Tsung-Wei Huang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Wu-Chia Lo
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan
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Batazzi A, Leng S, Ghionzoli M, Lo Piccolo R, Martin A, Facchini F, Messineo A. Thyroglossal duct cyst: Factors affecting cosmetic outcome and recurrence. Pediatr Int 2019; 61:1020-1024. [PMID: 31282046 DOI: 10.1111/ped.13955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 04/09/2019] [Accepted: 05/24/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Thyroglossal duct cyst (TDC) is the most common congenital abnormality in the neck in children. The purpose of this study was to perform a comprehensive review of all cases of TDC surgically treated at a single institution and to evaluate the factors that influence the rate of recurrence, and the aesthetic outcome of the surgery on follow up. METHODS All cases of TDC surgically treated at the Department of Pediatric Surgery at Meyer Hospital from January 2005 to December 2016 were selected. Charts from 248 patients were reviewed and risk factors for recurrence evaluated. A questionnaire was submitted to the patients' parents to determine if postoperative complications were present and standardized neck pictures were requested, to evaluate the cosmetic result . Microsoft Office Excel 2007 for Windows and Graphpad Prism 6 were used for data management and statistical analysis. RESULTS Simple cyst excision and post-inflammatory fibrosis (P < 0.05) were assessed as important risk factors for the recurrence of TDC. Recurrence rate on Sistrunk procedure was 5%. Variables such as post-inflammatory fibrosis before surgery (P < 0.001), the positioning of a drain (P < 0.01) and the development of recurrence (P < 0.001), negatively influenced the cosmetic result. No thyroglossal duct cyst carcinoma and no long-term postoperative complications were observed. CONCLUSIONS Recurrence rates were higher in patients who underwent simple cyst excision instead of the Sistrunk procedure, as already reported in literature. Presence of post-inflammatory fibrosis and positioning of the drain at surgery were associated with higher rates of recurrence, as well as worse cosmetic outcome.
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Affiliation(s)
- Andrea Batazzi
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Stella Leng
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Roberto Lo Piccolo
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Alessandra Martin
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Flavio Facchini
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Antonio Messineo
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
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Ha EJ, Baek SM, Baek JH, Shin SY, Han M, Kim CH. Efficacy and Safety of Ethanol Ablation for Branchial Cleft Cysts. AJNR Am J Neuroradiol 2017; 38:2351-2356. [PMID: 28970243 DOI: 10.3174/ajnr.a5373] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 07/10/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Branchial cleft cyst is a common congenital lesion of the neck. This study evaluated the efficacy and safety of ethanol ablation as an alternative treatment to surgery for branchial cleft cyst. MATERIALS AND METHODS Between September 2006 and October 2016, ethanol ablation was performed in 22 patients who refused an operation for a second branchial cleft cyst. After the exclusion of 2 patients who were lost to follow-up, the data of 20 patients were retrospectively evaluated. All index masses were confirmed as benign before treatment. Sonography-guided aspiration of the cystic fluid was followed by injection of absolute ethanol (99%) into the lesion. The injected volume of ethanol was 50%-80% of the volume of fluid aspirated. Therapeutic outcome, including the volume reduction ratio, therapeutic success rate (volume reduction ratio of >50% and/or no palpable mass), and complications, was evaluated. RESULTS The mean index volume of the cysts was 26.4 ± 15.7 mL (range, 3.8-49.9 mL). After ablation, the mean volume of the cysts decreased to 1.2 ± 1.1 mL (range, 0.0-3.5 mL). The mean volume reduction ratio at last follow-up was 93.9% ± 7.9% (range, 75.5%-100.0%; P < .001). Therapeutic success was achieved in all nodules (20/20, 100%), and the symptomatic (P < .001) and cosmetic (P < .001) scores had improved significantly by the last follow-up. In 1 patient, intracystic hemorrhage developed during the aspiration; however, no major complications occurred in any patient. CONCLUSIONS Ethanol ablation is an effective and safe treatment for patients with branchial cleft cysts who refuse, or are ineligible for, an operation.
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Affiliation(s)
- E J Ha
- From the Departments of Radiology (E.J.H., M.H.)
| | - S M Baek
- Department of Radiology (S.M.B., S.Y.S.), Sharing and Happiness Hospital, Busan, Korea
| | - J H Baek
- Department of Radiology and Research (J.H.B.), Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - S Y Shin
- Department of Radiology (S.M.B., S.Y.S.), Sharing and Happiness Hospital, Busan, Korea
| | - M Han
- From the Departments of Radiology (E.J.H., M.H.)
| | - C-H Kim
- Otolaryngology (C.-H.K.), Ajou University School of Medicine, Suwon, Korea
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11
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Arden RL, Miller LK. Application of Trotter Approach for Large Intralingual Thyroglossal Duct Cyst in an 88-Year-Old Patient. J Oral Maxillofac Surg 2017; 75:1921-1925. [PMID: 28284788 DOI: 10.1016/j.joms.2017.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 01/26/2017] [Accepted: 02/06/2017] [Indexed: 11/18/2022]
Abstract
Thyroglossal duct cysts (TDCs) are the most common congenital cyst formations in the neck, typically occurring at midline infrahyoid positions in younger patients. Traditional management has used the Sistrunk procedure to minimize recurrence rates. Reports on elderly patients are sparse, and currently only 16 cases have been reported in patients older than 70 years and 4 patients older than 80 years. This report describes the oldest known patient with TDC who had a purely intralingual location requiring a Trotter approach and a Sistrunk procedure for symptomatic management.
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Affiliation(s)
- Richard L Arden
- Chief of Otolaryngology-Head and Neck Surgery, Department of Surgery Division, William Beaumont Hospital, Troy, MI.
| | - Laura K Miller
- Resident, Department of Otolaryngology-Facial Plastic Surgery, Henry Ford Macomb Hospital, Clinton Township, MI
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12
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Chung MS, Baek JH, Lee JH, Choi YJ, Yoon JH, Nam SY, Kim SC, Sung JY, Baek SM, Na DG. Treatment Efficacy and Safety of Ethanol Ablation for Thyroglossal Duct Cysts: A Comparison with Surgery. Eur Radiol 2016; 27:2708-2716. [DOI: 10.1007/s00330-016-4659-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 11/04/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
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13
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Saylik M, Gökkuş K. Treatment of baker cyst, by using open posterior cystectomy and supine arthroscopy on recalcitrant cases (103 knees). BMC Musculoskelet Disord 2016; 17:435. [PMID: 27756267 PMCID: PMC5069796 DOI: 10.1186/s12891-016-1291-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022] Open
Abstract
Background Associated joint disorders with popliteal cysts were stated approximately between the ranges of 41–83 % in all reported cases. Combined treatment strategies that eliminate intra-articular pathologies and cyst- associated valve mechanisms are thought to be a good option in treatment of the disease. In this study, our main objective is to present clinical results of our combined treatment results, which includes posterior cyst excision with supine arthroscopic intervention, targeting intra-articular pathologies on recalcitrant cases. Methods One hundred three knees of 100 patients treated with posterior open cystectomy with valve and repair of posterior capsule, in addition to arthroscopic treatment of intra-articular lesions, were included in the study. Preoperative magnetic resonance imaging (MRI) studies were performed in order to evaluate location of Baker cysts behind the knee. Rauschning-Lindgren and Lysholm Knee Scoring Scales were used to assess pre/post-operative knee functions. Mann-Whitney U test was used to evaluate the differences between genders in comparison of Lysholm and Lindgren scores. Mean age within gender groups was compared using independent samples t-test. Wilcoxon test was used to compare the change in Lysholm and Lindgren scores. A p-value of less than 0.05 was considered to show a statistically significant result. Over the 1-year follow-up period, US and MR imaging was performed only with symptomatic patients. Results Cyst recurrence was seen only in 2 (1.94 %) patients. Post-operative Lysholm Knee and Lindgren knee scores demonstrated improvement in knee function and general comfort level of the patients. Conclusions Our midterm follow-up (Mean: 39 Months) results showed that open cyst excision with valve and capsule repair with knee arthroscopy that targets associated intra-articular pathologies reduced the pain and improved the knee function in those patients. Level of evidence IV (Retrospective clinical study without comparison group).
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Affiliation(s)
- M Saylik
- Orthopedics and Trauma Department, Attending orthopedic Surgeon, Bursa Medikal Park Hospital, Hasim Iscan Caddesi Fomara Meydanı No: 1 Osmangazi Bursa, Bursa, Turkey
| | - K Gökkuş
- Orthopedics and Trauma Department, Attending orthopedic Surgeon, Memorial Antalya Hospital, Zafer Mah. Yildirim Beyazit Cad. Number: 91 Kepez, Antalya, Turkey.
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Yavuz F, Kibar S, Balaban B. Hypertonic Dextrose Injection for The Treatment of a Baker's Cyst. J Clin Diagn Res 2016; 10:YD01-2. [PMID: 27042572 DOI: 10.7860/jcdr/2016/17919.7290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/04/2016] [Indexed: 11/24/2022]
Abstract
We present extremely rare and interesting case of a Baker's cyst treated with hypertonic dextrose injection. A 54-year-old female patient had a Baker's cyst which was diagnosed by an ultrasonography. After the failure of the two-weekly conservative treatment, we injected hypertonic dextrose (25%) into her right knee joint for the treatment of a Baker's cyst. Two weeks after the injection, the patient reported improvement in posterior knee pain, and an US showed a resolution of the posterior knee cyst. Certainly hypertonic dextrose injection for the treatment of a Baker's cyst appears to be a reasonable treatment option. Further studies are needed in order to elucidate the efficacy of hypertonic dextrose injection in the treatment of Baker's cysts.
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Affiliation(s)
- Ferdi Yavuz
- The Clinic of Physical Therapy and Rehabilitation, The Fizyocare Medical Center , Ankara-Turkey
| | - Sibel Kibar
- The Clinic of Physical Therapy and Rehabilitation, The Fizyocare Medical Center , Ankara-Turkey
| | - Birol Balaban
- Professor, Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, European University of Lefke, Lefke-Mersin, Turkey; The Clinic of Physical Therapy and Rehabilitation, The Fizyocare Medical Center , Ankara-Turkey
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15
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Kandula M, Moole H, Cashman M, Volmar FH, Bechtold ML, Puli SR. Success of endoscopic ultrasound-guided ethanol ablation of pancreatic cysts: a meta-analysis and systematic review. Indian J Gastroenterol 2015; 34:193-9. [PMID: 26108653 DOI: 10.1007/s12664-015-0575-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 05/14/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided ethanol ablation has emerged as an efficacious and safe alternative management option for pancreatic cysts. We undertook a meta-analysis and systematic review to assess the overall safety and efficacy of EUS-guided ethanol ablation of pancreatic cysts. METHOD STUDY SELECTION CRITERIA EUS-guided ethanol ablation of pancreatic cysts. DATA COLLECTION EXTRACTION Articles were searched in Medline, Pubmed, and Ovid journals. STATISTICAL METHOD Fixed and random effects models were used to calculate the pooled proportions. RESULTS Initial search identified 1,319 reference articles, in which 120 relevant articles were selected and reviewed. Data was extracted from seven studies (n = 152) of EUS-guided ethanol ablation of pancreatic cysts, which met the inclusion criteria. With EUS-guided ethanol ablation, the pooled proportion of patients with complete cyst resolution was 56.20 % (95 % CI = 48.16 to 64.08) and partial cyst resolution was 23.72 % (95 % CI = 17.24 to 30.89). Postprocedural complications after ablation were significant for abdominal pain in 6.51 % (95 % CI = 3.12 to 11.04) and pancreatitis in 3.90 % (95 % CI = 1.39 to 7.60) of the pooled percentage of patients. Publication bias calculated using Harbord-Egger bias indicator gave a value of -1.09 (95 % CI = 10.21 to 8.03, p = 0.77). The Begg-Mazumdar indicator gave a Kendall's tau b value of 0.05 (p ≥ 0.99). CONCLUSIONS EUS-guided ethanol ablation may be a safe alternative treatment modality for pancreatic cysts, with acceptable intraprocedural and postprocedural complications. However, due to the limited data available, prospective randomized controlled trials with a long follow up period are required in this area.
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Affiliation(s)
- Manasa Kandula
- Division of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA,
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Pastore V, Bartoli F. "Extended" Sistrunk procedure in the treatment of recurrent thyroglossal duct cysts: a 10-year experience. Int J Pediatr Otorhinolaryngol 2014; 78:1534-6. [PMID: 25048858 DOI: 10.1016/j.ijporl.2014.06.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/25/2014] [Accepted: 06/28/2014] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Valentina Pastore
- Pediatric Surgery Unit, Medical and Surgical Sciences Department, University of Foggia, Italy.
| | - Fabio Bartoli
- Pediatric Surgery Unit, Medical and Surgical Sciences Department, University of Foggia, Italy
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Abstract
Baker's cyst, or popliteal cyst, is a fluid-filled mass that is a distention of a preexisting bursa in the popliteal fossa, most commonly the gastrocnemio-semimembranosus bursa. This bursa is unique in that it communicates with the knee joint, unlike other periarticular bursae, via an opening in the joint capsule posterior to the medial femoral condyle. Many have theorized that this opening creates a valve-like mechanism in the presence of effusion that contributes to the formation of these cysts in adults. Popliteal cysts rarely manifest alone and are most often found in conjunction with other intra-articular pathologies and inflammatory conditions, such as osteoarthritis, meniscus tears, and rheumatoid arthritis. In children, popliteal cysts are only occasionally associated with these conditions and are more often an incidental finding discovered during a routine physical examination. Popliteal cysts may present as either a chronically persistent or relapsing condition or as an acute and dramatic condition that can occur in the case of cyst rupture presenting as pseudothrombophlebitis. Ultrasound and magnetic resonance imaging have proven to be consistent and accurate in the confirmation of popliteal cysts, with magnetic resonance imaging becoming the modern imaging modality of choice. This review discusses the anatomy and etiology of popliteal cysts, describes the common clinical presentations, reviews the differential diagnoses, and provides guidance for proper diagnostic imaging. It also provides a comparison of current conservative, minimally invasive, and invasive treatment options, along with a discussion of results. Postoperative rehabilitation depends largely on the condition associated with the popliteal cyst.
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18
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Lee DK, Seo JW, Park HS, Kang MK, Jang AL, Lee JH, Hong JC. Efficacy of Ethanol Ablation for Thyroglossal Duct Cyst. Ann Otol Rhinol Laryngol 2014; 124:62-7. [PMID: 25048959 DOI: 10.1177/0003489414542845] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Ethanol ablation has been known as an effective, easy, and safe treatment of cystic thyroid lesions. The objective of the present study was to evaluate efficacy of ethanol ablation as a minimally invasive management of thyroglossal duct cyst (TGDC). Methods: Between January 2012 and July 2013, 9 TGDC patients were diagnosed and treated with ethanol ablation. We evaluated the treatment outcomes with the change of volume reduction and the improvement of symptomatic and cosmetic complaints and complications. Results: Initial mean tumor volume was 8.9 mL (range, 0.2-36.9 mL) in ultrasonography. The mean number of the treatment sessions was 1.7 (range, 1-3 sessions). At last follow-up, the mean volume of the treated thyroglossal duct cyst decreased significantly from 8.9 mL to 1.9 mL ( P = .019; volume reduction rate = 76.6%). Treatment success rate was 77.8% (7/9). Mean symptoms and cosmetic-grading scores improved from 5.2 to 3.1 and from 5.3 to 3.1 ( P = .062). No significant complications were observed during follow-up. Conclusion: Ethanol ablation is a feasible and convenient procedure without surgical scars and hospitalization for TGDC patients. Favorable outcomes can be achieved without significant complications.
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Affiliation(s)
- Dong Kun Lee
- Department of Otolaryngology–Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Ji Won Seo
- Department of Otolaryngology–Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Heon Soo Park
- Department of Otolaryngology–Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Myung Koo Kang
- Department of Otolaryngology–Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Ae Lan Jang
- Department of Otolaryngology–Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Joon Hyung Lee
- Department of Radiology, Dong-A University College of Medicine, Busan, Korea
| | - Jong Chul Hong
- Department of Otolaryngology–Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
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Affiliation(s)
- S. Østergaard
- Large Animal Hospital; Copenhagen University; Taastrup Denmark
| | - A. Tnibar
- Large Animal Hospital; Copenhagen University; Taastrup Denmark
| | - L. Boulouha
- Laboratoire Idexx Alfort; Alfortville France
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Kim JH. Ultrasound-guided sclerotherapy for benign non-thyroid cystic mass in the neck. Ultrasonography 2014; 33:83-90. [PMID: 24936500 PMCID: PMC4058977 DOI: 10.14366/usg.13026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 01/28/2014] [Indexed: 11/03/2022] Open
Abstract
Surgical excision has traditionally been the treatment of choice for benign non-thyroid cystic neck masses, including lymphatic malformation, ranula, branchial cleft cyst, thyroglossal duct cyst, and parathyroid cyst. However, there is a tendency toward recurrence after surgery, and surgery may be accompanied by complications, including nerve injuries, vascular injuries, and scar formation. Ultrasound-guided sclerotherapy using various agents has been challenged and successfully applied as an alternative treatment for benign non-thyroid cystic neck masses. This report reviews the available sclerosing agents and describes the applications of sclerotherapy to the treatment of benign cystic masses in the neck.
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Affiliation(s)
- Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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21
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de Estrada J, Schumacher J. Treatment of an 18-year-old mare for bilateral, branchial remnant cysts. EQUINE VET EDUC 2013. [DOI: 10.1111/j.2042-3292.2012.00413.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Ghosh SK, Kr T, Datta S, Banka A. Parapharyngeal second branchial cyst: A case report. Indian J Otolaryngol Head Neck Surg 2012; 58:283-4. [PMID: 23120316 DOI: 10.1007/bf03050843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Branchial cleft cysts extending to the lateral wall of the pharynx are rare. An eight year old female child presented with a cystic swelling in the left parotid region. A bluish cyst was seen anterior to the anterior pillar of left tonsil. CT scan showed the cyst extending into left parapharyngeal space. External part of the cyst was excised via a transcervical approach and the internal part was marsupalised per orally.
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Abstract
Pancreatic cystic neoplasms represent a wide spectrum of invariably benign to precancerous and malignant tumors. Endoscopic ultrasound-guided pancreatic cyst ablation with ethanol and/or paclitaxel offers a nonoperative treatment for patients refusing or not eligible for surgery. Histopathology after resection in these patients has shown variable degrees of cyst epithelial ablation ranging from 0% to 100%. Future research investigating the safety of this procedure, modifications of reported ablation techniques, choice and number of the lavage agents used, and criteria to optimize selection of the appropriate pancreatic cysts for treatment is needed.
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Affiliation(s)
- John DeWitt
- Division of Gastroenterology and Hepatology, Indiana University Medical Center, 550 North University Boulevard, UH 4100, Indianapolis, IN 46202, USA.
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24
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Chow TL, Choi CY, Hui JYH. Thyroglossal duct cysts in adults treated by ethanol sclerotherapy: a pilot study of a nonsurgical technique. Laryngoscope 2012; 122:1262-4. [PMID: 22461135 DOI: 10.1002/lary.23254] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 01/09/2012] [Accepted: 01/30/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the effect of ethanol sclerotherapy on the thyroglossal duct cyst (TDC). STUDY DESIGN Prospective case series. METHODS Patients with primary TDC were enrolled. The volume of the TDC was calculated using the following formula: length × width × height × π/6. Under sonographic guidance, ethanol was slowly instilled into the TDC cavity after the cyst fluid was aspirated. The procedure was performed in an outpatient setting. RESULTS A total of eight patients were recruited for this study, but two of them did not receive sclerotherapy. One patient refused treatment after obtaining initial consent, and another patient was not treated due to a technical issue. The median follow-up duration was 21 months. The median cyst volume was 3.5 mL. Of the six patients given sclerotherapy, recurrent TDC occurred in one patient. As expected, the TDC persisted in the two patients who had not undergone sclerotherapy. Two patients experienced moderate pain after the procedure that was well controlled with oral analgesics. No major complications arose, and no patient needed hospitalization because of treatment complications. CONCLUSIONS Percutaneous ethanol sclerotherapy is an effective minimally invasive modality of therapy for TDC. Further studies with longer follow-up are warranted.
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Affiliation(s)
- Tam-Lin Chow
- Department of Surgery, United Christian Hospital, Kowloon, Hong Kong.
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25
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Ablation of pancreatic cystic lesions: the use of multiple endoscopic ultrasound-guided ethanol lavage sessions. Pancreas 2011; 40:664-8. [PMID: 21562447 DOI: 10.1097/mpa.0b013e3182128d06] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Determine the effectiveness of multiple endoscopic ultrasound-guided ethanol lavage (EUS-EL) sessions for attempted ablation of pancreatic cystic lesion (PCL). METHODS Retrospective review of patients who have undergone 2 or more EUS-EL treatments of a PCL. Eligible patients had asymptomatic, benign-appearing PCL, no previous pancreatitis, and were considered poor surgical candidates. RESULTS Final analysis was performed on 13 patients with suspected branch duct intraductal papillary mucinous neoplasms. The mean maximum cyst diameter at baseline and after 1 and 2 EUS-EL treatments was 20.1 ± 7.1, 17.0 ± 9.8 (P = 0.06), and 12.8 ± 9.6 mm (P = 0.0002), respectively. The mean surface area after 2 EUS-EL sessions: baseline, 5734 ± 6846 mm(2); 1 EUS-EL session, 4906 ± 9240 mm(2) (P = 0.52); and 2 EUS-EL sessions, 2311 ± 4093 mm(2) (P = 0.008). Complete resolution of the cystic lesion was not seen by computed tomography or magnetic resonance imaging in any patient after 1 EUS-EL but occurred in 5 (38%; P = 0.02) of 13 patients after 2 EUS-EL treatments. One patient had minor abdominal pain 1 day after the first EUS-EL session and 2 days after the second session. CONCLUSIONS Compared with only 1 EUS-EL, 2 EUS-EL treatment results in a significantly greater decrease in the size and surface area of PCL and is associated with a significantly higher rate of image-defined cyst resolution.
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Ahmed M, Brace CL, Lee FT, Goldberg SN. Principles of and advances in percutaneous ablation. Radiology 2011; 258:351-69. [PMID: 21273519 DOI: 10.1148/radiol.10081634] [Citation(s) in RCA: 529] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Image-guided tumor ablation with both thermal and nonthermal sources has received substantial attention for the treatment of many focal malignancies. Increasing interest has been accompanied by continual advances in energy delivery, application technique, and therapeutic combinations with the intent to improve the efficacy and/or specificity of ablative therapies. This review outlines clinical percutaneous tumor ablation technology, detailing the science, devices, techniques, technical obstacles, current trends, and future goals in percutaneous tumor ablation. Methods such as chemical ablation, cryoablation, high-temperature ablation (radiofrequency, microwave, laser, and ultrasound), and irreversible electroporation will be discussed. Advances in technique will also be covered, including combination therapies, tissue property modulation, and the role of computer modeling for treatment optimization.
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Affiliation(s)
- Muneeb Ahmed
- Laboratory for Minimally Invasive Tumor Therapy, Section of Interventional Radiology, and Section of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215, USA.
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Kim SM, Baek JH, Kim YS, Sung JY, Lim HK, Choi H, Lee JH. Efficacy and safety of ethanol ablation for thyroglossal duct cysts. AJNR Am J Neuroradiol 2010; 32:306-9. [PMID: 21087937 DOI: 10.3174/ajnr.a2296] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE TGDC is a common congenital neck lesion, which has been treated by surgery. Although surgery is curative, it has drawbacks such as scars and surgical morbidity. Therefore, we applied EA as an alternative treatment technique. The purpose of this study was the evaluation of the efficacy and safety of EA for TGDC. MATERIALS AND METHODS Between May 2005 and July 2008, we performed EA in 11 patients with TGDC who refused surgery. All patients were confirmed as having benign lesions before treatment. US-guided aspiration of the cystic fluid was followed by injection of absolute ethanol (99%). The injected volume of ethanol was 50%-80% of the volume of fluid aspirated. We evaluated the therapeutic outcome, including volume reduction of the TGDC, improvement of cosmetic problems and symptoms, and complications. RESULTS The initial volume of the cysts ranged from 0.67 to 29.39 mL (mean, 6.0 mL). The procedure was performed in 1-3 sessions (mean, 1.4 sessions). Follow-up US was performed in 10 patients from 3 to 29 months (mean, 13.6 months). The mean volume of the cyst was 6.0 ± 8.4 mL, and volume reduction was 43.9%-100% (mean, 81.3%, P = .005) at last follow-up. Therapeutic success (volume reduction of >50%) was observed in 8 patients (8/10, 80%). Significant improvement of symptom- (P = .005) and cosmetic-grading scores (P = .003) was observed at last follow-up. No significant complications were observed during the procedure or follow-up periods. CONCLUSIONS EA seems to be an effective and safe treatment method for TGDC.
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Affiliation(s)
- S M Kim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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DeWitt J, McGreevy K, Schmidt CM, Brugge WR. EUS-guided ethanol versus saline solution lavage for pancreatic cysts: a randomized, double-blind study. Gastrointest Endosc 2009; 70:710-23. [PMID: 19577745 DOI: 10.1016/j.gie.2009.03.1173] [Citation(s) in RCA: 187] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Accepted: 03/27/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgery for pancreatic cysts is associated with significant morbidity. A pilot study previously demonstrated the safety of EUS-guided ethanol lavage of pancreatic cysts. OBJECTIVE To determine whether EUS-guided ethanol lavage would decrease pancreatic cyst size more than saline solution lavage. DESIGN Prospective, multicenter, randomized trial. SETTING Two tertiary referral hospitals in the United States. PATIENTS Patients referred for EUS with a 1- to 5-cm unilocular pancreatic cyst were randomized to blinded ethanol or saline solution lavage. Three months later, the cyst diameter was remeasured by EUS, and a second unblinded ethanol lavage was performed. INTERVENTIONS EUS-guided pancreatic cyst lavage. MAIN OUTCOME MEASUREMENTS Cyst ablation based on size changes from follow-up EUS, CT, and histology of resected specimens. RESULTS Of 58 patients randomized, 16 were excluded and 42 underwent initial ethanol (n = 25) or saline solution (n = 17) lavage. Ethanol lavage resulted in a greater mean percentage of decrease in cyst surface area (-42.9; 95% CI, -58.4 to -27.4) compared with saline solution alone (-11.4; 95% CI, -25.0 to 2.2; P = .009). Nineteen (76.0%) of 25 and 14 (82.3%) of 17 patients randomized to ethanol and saline solution, respectively, underwent a second ethanol lavage. A follow-up CT scan demonstrated resolution in 12 (33.3%) of 36 cysts. Histology of 4 resected cysts demonstrated epithelial ablation ranging from 0% (saline solution alone) to 50% to 100% (1 or 2 ethanol lavages). Complication rates were similar in all groups. LIMITATION Short-term follow-up. CONCLUSIONS EUS-guided ethanol lavage results in a greater decrease in pancreatic cyst size compared with saline solution lavage with a similar safety profile. Overall CT-defined complete pancreatic cyst ablation was 33.3%.
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Affiliation(s)
- John DeWitt
- Department of Gastroenterology and Hepatology, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Roh JL, Sung MW, Hyun Kim K, Il Park C. Treatment of branchial cleft cyst with intracystic injection of OK-432. Acta Otolaryngol 2009; 126:510-4. [PMID: 16698701 DOI: 10.1080/00016480500437443] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CONCLUSIONS The data suggest that branchial cleft cyst (BCC) can be primarily treated with OK-432 sclerotherapy and only the remaining lesions with excision. OBJECTIVES To evaluate the effectiveness of sclerotherapy using OK-432 in the treatment of BCC. MATERIALS AND METHODS We treated 12 BCC patients (3 males and 9 females; mean age 25 years) with OK-432 sclerotherapy at an outpatient clinic. The cystic fluids were aspirated and diagnosed by cytomorphology and DNA cytometric analysis to exclude malignancy. The fluid aspirated from the cyst was replaced with an equal volume of OK-432 solution. The sizes of cysts were measured and compared before and after injection. The remaining cysts were excised and histopathologically compared with the excised BCCs that had not been treated with OK-432. RESULTS Seven of 12 patients (58%) showed a complete response after OK-432 injection, administered one to three times. Three patients (25%) had only partial response and two (17%) were stationary. Five patients with remaining lesions underwent excision. There was no difficulty in dissecting around the cysts and no increased morbidity during operation. None of the patients had evidence of recurrences or malignancies developing during the follow-up period (mean 21 months, range 17-26 months). There were no major side effects except fever after sclerotherapy.
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Affiliation(s)
- Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
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Abstract
BACKGROUND AND OBJECTIVES In general, benign neck cysts are treated by surgical excision. This can present technical difficulties and frequent recurrences, because of insufficient surgery. Sclerosing agents such as OK-432 have been tested for the nonsurgical treatment of these cysts. We have assessed the efficacy of OK-432 sclerotherapy for benign neck cysts. MATERIALS AND METHODS The study group consisted of 75 patients (42 men, 33 women) diagnosed with and treated for benign neck cysts between March 2001 and December 2007 by intralesional injection of OK-432. The liquid content of each cyst was aspirated as much as possible, and the same volume of OK-432 solution was injected. Patients were assessed by ultrasonography or computerized tomography, and therapeutic outcomes and adverse effects were evaluated by patient age, sex, cyst type, and number of injections. RESULTS Of the 75 treated patients, 31 (41.3%) showed total shrinkage, seven (9.3%) showed near-total shrinkage (>90% of cyst volume), five (6.6%) showed marked shrinkage (>70% of cyst volume), and 17 (22.7%) showed partial shrinkage (<70% of cyst volume). No response was seen in 15 patients (20%). Despite repeated sclerotherapy, eight patients (10.7%) showed recurrences. Minor adverse effects of therapy included fever, localized pain, and odynophagia but these complications spontaneously disappeared within several days. CONCLUSIONS OK-432 sclerotherapy is a safe and effective primary alternative to surgery in patients with benign neck cysts.
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DAVID FLORENT, SAVARD CLAUDINE, DROLET RICHARD, ALEXANDER KATE, PANG DANIELSJ, LAVERTY SHEILA. Congenital Branchial Apparatus Malformation in a Haflinger Colt. Vet Surg 2008; 37:3-11. [DOI: 10.1111/j.1532-950x.2007.00339.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Al-Khateeb TH, Al Zoubi F. Congenital neck masses: a descriptive retrospective study of 252 cases. J Oral Maxillofac Surg 2007; 65:2242-7. [PMID: 17954320 DOI: 10.1016/j.joms.2006.11.039] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 11/04/2006] [Accepted: 11/19/2006] [Indexed: 10/22/2022]
Abstract
PURPOSE This retrospective study was conducted to analyze congenital neck masses in Jordanians compared with international findings. PATIENTS AND METHODS The records of patients with congenital neck masses between 1991 and 2002 were retrieved from the Department of Pathology, Jordan University of Science and Technology, and analyzed for age, gender, location, clinical features, and treatment. RESULTS Within the 12-year period of the study, a total of 2,063 neck mass lesions were found; of these, 252 (12%) were congenital masses. These cases were distributed into 166 (66%) midline, 55 (22%) lateral, and 31 (12%) entire neck masses. The most frequent mass was thyroglossal duct cyst (fistulas) (53%), followed by cysts (fistulas) of the branchial apparatus (22%), dermoid cysts (11%), hemangiomas (7%), and 1ymphangiomas (6%). The majority of branchial arch anomalies (85%) were of the second arch. The mean age of patients was 16 years, with the greatest number of cases (38%) in the first decade. The male-to-female ratio was 1:1.2, with most lesions affecting females. The majority of lesions presented with painless neck swelling, and all lesions were surgically excised. CONCLUSIONS The overall frequency and age distribution of congenital neck masses in northern Jordanians are similar to international findings. However, the gender distribution and relative frequency of individual types of neck masses are somewhat different from those in other countries. These differences may be attributed to genetic and geographic differences.
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Affiliation(s)
- Taiseer Hussain Al-Khateeb
- Department of Oral Surgery and Medicine, Consultant in Oral and Maxillofacial Surgery, Jordan University of Science and Technology, Irbid, Jordan.
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Abstract
OBJECTIVE To report the results of treating 3 patients with a thyroglossal duct cyst by percutaneous ethanol injection and compare the outcome with the results of treatment in 17 patients with thyroid cysts. METHODS The details of the ultrasound-guided injection procedure and the clinical course of the patients are presented, along with review of the literature pertaining to alcohol ablation for thyroglossal duct cysts. RESULTS Percutaneous ethanol injection was successful in only 1 of 3 patients with thyroglossal duct cysts, in whom the diagnosis was confirmed by ultrasonography, during a 2-year period. During the same 2-year interval, 17 patients with a thyroid cyst received similar treatment. Ablation of the thyroid cyst was successful in all 17 patients, only 1 of whom required a second ethanol injection procedure. CONCLUSION Percutaneous ethanol injection does not seem to be as effective in treating thyroglossal duct cysts as in treating thyroid cysts. If the presence of a malignant lesion can be excluded, percutaneous ethanol injection may be considered a secondary treatment in patients with thyroglossal duct cysts who cannot undergo a surgical procedure.
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Affiliation(s)
- H Jack Baskin
- Florida Thyroid and Endocrine Clinic, Orlando, Florida 32804, USA
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Valcavi R, Frasoldati A. Ultrasound-Guided Percutaneous Ethanol Injection Therapy in Thyroid Cystic Nodules. Endocr Pract 2004; 10:269-75. [PMID: 15310546 DOI: 10.4158/ep.10.3.269] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To provide an overview of ultrasound (US)-guided percutaneous ethanol injection (PEI) therapy for thyroid cystic nodules and discuss the practical and technical details. METHODS We present preliminary data of a controlled randomized study involving 281 patients (221 women and 60 men; 18 to 85 years old) with benign thyroid cystic nodules. Study inclusion criteria were local discomfort or cosmetic damage, cystic volume more than 2 mL, 50% or more fluid component, benignity as confirmed by cytologic specimen obtained by US-guided fine-needle aspiration biopsy (FNAB), and euthyroidism. Exclusion criteria were inadequate, suspicious, or positive FNAB cytology, high serum calcitonin, and contralateral laryngeal cord palsy. By random assignment, 138 patients underwent simple cyst evacuation, and 143 underwent cyst evacuation plus PEI by a skilled operator using a US-guided technique. The amount of ethanol injected was 50 to 70% of the cystic fluid extracted. RESULTS Before treatment, the mean (+/-SD) nodule volume was 19.0 +/- 19.0 mL versus 20.0 +/- 13.4 mL in the PEI versus the simple evacuation group (no significant difference). After 1 year, volumes were 5.5 +/- 11.7 mL versus 16.4 +/- 13.7 mL (P<0.001), with a median 85.6% versus 7.3% reduction, respectively (P<0.001), of the initial volume. The median nodule volume reduction after PEI was 88.8% and 65.8% in empty body and mixed thyroid cysts, respectively. Compressive and cosmetic symptoms disappeared in 74.8% and 80.0% of patients treated with PEI versus 24.4% and 37.4% of patients treated with simple evacuation, respectively (P<0.001). Side effects were minor. CONCLUSION These data provide definitive evidence that PEI is a safe and effective treatment for thyroid cystic nodules. Unicameral thyroid cysts are the most suitable candidate nodules for PEI.
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Affiliation(s)
- Roberto Valcavi
- Endocrine Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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Brousseau VJ, Solares CA, Xu M, Krakovitz P, Koltai PJ. Thyroglossal duct cysts: presentation and management in children versus adults. Int J Pediatr Otorhinolaryngol 2003; 67:1285-90. [PMID: 14643470 DOI: 10.1016/j.ijporl.2003.07.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine if the clinical presentation of thyroglossal duct cysts (TGDC) varies between children and adults and whether this knowledge helps optimize the surgical management. METHODS We retrospectively identified all patients with TGDC managed in our department between 1992 and 2002. We reviewed the patients' charts and recorded their gender, age at diagnosis, clinical presentation, radiologic imaging, surgical management, post-operative complications, and recurrence rate and compared the variables between the children and adults. RESULTS Twenty-one children and 41 adults were treated for TGDC. Of the children, 57% were male and 43% were female, whereas 49% of the adults were male and 51% were female (P = 0.53). The average age was 6 +/- 5 years in children and 45 +/- 16 years in adults, which demonstrates a bimodal distribution. Forty-three percent of children and 42% of adults presented with an infected neck mass (P > 0.99). Among our patients, 96% of the adults and 100% of the children underwent a Sistrunk operation. Four children developed a wound infection that resolved with antibiotics. One adult developed a haematoma and another developed a wound seroma. There was one recurrence among adults and one among children, both of whom were treated with a second Sistrunk procedure. CONCLUSIONS There appears to be a bimodal distribution for age at presentation of TGDC. Since the differential diagnosis among adults is broader, the opportunity for misdiagnosis is greater. However, once the correct diagnosis is made, the surgical management and post-operative outcome between adults and children is the same.
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Dedivitis RA, Camargo DL, Peixoto GL, Weissman L, Guimarães AV. Thyroglossal duct: a review of 55 cases. J Am Coll Surg 2002; 194:274-7. [PMID: 11893130 DOI: 10.1016/s1072-7515(01)01171-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Thyroglossal duct remnants are the most common midline neck masses in childhood but can be found in adults and the elderly. Sistrunk's procedure, with dissection of the tract and removal of the hyoid bone, is accepted as the main operation of choice. STUDY DESIGN Fifty-five patients were treated from January 1994 to November 2000, and these were studied. There were 29 men and 26 women, with a median age of 17 years. Diagnosis was clinical, with 13 cases of fistula and 42 of cyst. Size varied from 1.0 to 4.0 cm, with an average of 2.5 cm. Six patients presented with local abscess. RESULTS All the patients underwent Sistrunk's procedure. Serum collection occurred in three patients as complication. In one patient papillary carcinoma was identified in the cyst. Total thyroidectomy was not performed. There was only one recurrence, managed with a second operation. CONCLUSIONS We concluded that the diagnosis of thyroglossal duct is clinical. Sistrunk's procedure carries low rates of complications (9.08%) and recurrence (1.82%). Antibiotic therapy is avoidable as a rule and hospital stay is short.
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Abstract
OBJECTIVE To review the epidemiology, clinical presentation, pathogenesis, imaging, differential diagnosis, complications, and treatment of popliteal cysts. METHODS References were taken from MEDLINE from 1985 to 1998 under the subject "Popliteal Cyst" with subheadings of Radiography, Ultrasonography, and Radionuclide Imaging. Other pertinent references were used. Childhood cysts were excluded. RESULTS Depending on the studied population and the imaging technique, 5% to 32% of knee problems may have these cysts, with 2 age-incidence peaks of 4 to 7 years and 35 to 70 years. In older patients there is usually coexistent joint pathology. Symptoms may arise in the popliteal fossa from the cyst itself or be dominated by knee pain from coexisting knee pathology. Many cysts are asymptomatic. Physical examination will miss one half of these cysts. Pathogenesis depends on the connection between the joint and bursa, with a valvelike effect allowing passage of fluid from the joint into the bursa with subsequent distention producing these cysts. Some bursae have no such joint-bursal communication, and the cysts arise primarily as bursitis of the gastrocnemio-semimembranosus bursa. Imaging is performed by plain x-ray, ultrasound, arthrography, computerized axial tomography, magnetic resonance imaging, or nuclear scan; sonography is the method of choice. Complicated cysts with extension or rupture into the calf mimic phlebitis, an important differential diagnosis. Asymptomatic cysts found incidentally need no treatment; most symptomatic cysts respond to intra-articular corticosteroid injections. Surgical excision is rarely necessary. CONCLUSIONS AND RELEVANCE Popliteal cysts are fairly common, may not be found on physical examination, require imaging (preferably sonography) to be identified, mimic phlebitis when extending into the calf, and often respond to intra-articular steroid or, rarely, surgical resection.
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Affiliation(s)
- J R Handy
- Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta, GA, USA
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Josephson GD, Spencer WR, Josephson JS. Thyroglossal Duct Cyst: The New York Eye and Ear Infirmary Experience and a Literature Review. EAR, NOSE & THROAT JOURNAL 1998. [DOI: 10.1177/014556139807700813] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Gary D. Josephson
- Division of Pediatric Otolaryngology, Department of Otolaryngology— Head and Neck Surgery, University of Miami, Miami, Florida
| | - William R. Spencer
- Department of Otolaryngology—Head and Neck Surgery, The New York Eye and Ear Infirmary/ New York Medical College, New York, New York
| | - Jordan S. Josephson
- Department of Otolaryngology—Head and Neck Surgery, The New York Eye and Ear Infirmary/ New York Medical College, New York, New York
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Abstract
BACKGROUND/PURPOSE Cystic lesions of the thyroid encompass a wide and heterogeneous group of disease states in children, ranging from benign purely cystic entities to malignant tumors. The purpose of this study was to study both the presentation and management of cystic thyroid lesions in the pediatric population. METHODS A retrospective review of all thyroid masses presenting between 1978 and 1996 and found to be purely or partially cystic on ultrasound examination was conducted, looking at presentation, family history, laboratory values, ultrasound scan and radionuclide imaging, and pathological and cytological evaluation. RESULTS Twenty-four patients (19 girls, 5 boys) aged 6 to 18 years received the diagnosis of cystic lesions of the thyroid. Of these, 23 presented with painless neck masses, 21 were clinically euthyroid, only one had a single abnormal thyroid function test, only two had mildly positive antithyroid antibody test results, and nearly 30% had a positive family history of thyroid disease. Ultrasonography showed pure cysts in five patients and mixed solid cystic lesions in 19 patients. On scintiscan, six lesions were hot, 13 were cold, three showed normal uptake, and two were mixed. Treatment included either observation, aspiration, cyst sclerosis, surgery, or combinations thereof. Pathological and cytological results included follicular adenoma (n = 9), cystic degeneration (n = 6), multinodular goiter (n = 4), carcinoma (n = 2), branchial cleft cyst (n = 1), and undetermined (n = 2). CONCLUSIONS Thyroid cysts are often thought to represent benign degenerative disease. Our study, which is the first in the literature to specifically address thyroid cysts in children, shows that ultrasound scan is useful in evaluating thyroid masses, whereas laboratory and radionuclide are of less value, and that single lesions of mixed echogeneity are likely to represent neoplasms, a significant percentage of which are malignant.
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Affiliation(s)
- A Yoskovitch
- Department of Otolaryngology, Montreal Children's Hospital, McGill University, Quebec, Canada
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Abstract
OBJECTIVES To increase awareness of entrapment neuropathy caused by rupture of Baker's cyst. METHODS A patient with psoriatic arthritis, ruptured Baker's cyst, and entrapment neuropathy is reported and the literature on this complication is reviewed. RESULTS Nerve entrapment caused by rupture of Baker's cyst is rare. Neurological examination and demonstration of Baker's cyst by Color Doppler Duplex Ultrasound (CDDU) help in making the diagnosis. Nerve Conduction Study (NCS) may confirm the diagnosis of posterior tibial nerve entrapment. CONCLUSIONS Peripheral nerve entrapment should be considered in patients with Baker's cysts and loss of sensation along the plantar aspect of the foot or other neurological symptoms or findings.
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Affiliation(s)
- S Dash
- Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick 08903-0019, USA
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Langsfeld M, Matteson B, Johnson W, Wascher D, Goodnough J, Weinstein E. Baker's cysts mimicking the symptoms of deep vein thrombosis: diagnosis with venous duplex scanning. J Vasc Surg 1997; 25:658-62. [PMID: 9129621 DOI: 10.1016/s0741-5214(97)70292-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to determine the incidence and characteristics of Baker's cysts discovered during venous duplex examinations to rule out deep vein thrombosis (DVT). METHODS We reviewed the vascular laboratory charts of patients found to have Baker's cysts during venous duplex studies to rule out DVT from October 1988 through December 1995. RESULTS Ninety-five (3.1%) of 3072 patients who underwent venous duplex studies were found to have 111 Baker's cysts. Seven of the 95 had coexistent DVT. Ten patients had ruptured cysts, whereas six patients had cysts that compressed the popliteal vein. CONCLUSION The presentation of DVT and that of a Baker's cyst are similar enough to be difficult to distinguish by clinical examination. Careful examination of the popliteal fossa should be performed during venous duplex examinations regardless of the indication for the study.
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Affiliation(s)
- M Langsfeld
- Department of Vascular Surgery, University of New Mexico, Albuquerque 87131, USA
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