Recurrent Thyroglossal Duct Cysts Research Articles

OK-432 treatment of pediatric patients with recurrent thyroglossal duct cyst after surgery.

<b>Introduction:</b> Recurrent thyroglossal duct cyst after surgery is not a rare condition and first-line treatment has not been established yet.<br/><br/> <b>Aim:</b> Evaluation of outcomes and complications of OK-432 treatment in patients with recurrent thyroglossal duct cyst after surgery. <br/><br/> <b>Material and methods:</b> This study is designed as a case series with planned data collection at Tohoku Medical and Pharmaceutical University and Fukase Clinic. Five patients with recurrent thyroglossal duct cyst after surgery received this therapy between January 2014 and February 2020 on an outpatient basis, without hospitalization. OK-432 solution was injected into the lesion using an 18- or 27-gauge needle, depending on the location and size of the lesion, as well as on possible complications.<br/> <br/> <b>Results:</b> Lesions showed marked reduction or total shrinkage in all patients, with no local scarring or deformity at the injection site. Side effects manifested as local pain at the site of injection and fever (37.5-38.5°C) observed in three patients, but the symptoms resolved within a few days.<br/> <br/> <b>Conclusions:</b> Since OK-432 therapy is simple, easy, safe and effective, it can be used as an alternative to surgery in the treatment of recurrent thyroglossal duct cyst after surgery.

Infected Recurrent Thyroglossal Duct Cyst: A Case Report

IntroductionA thyroglossal duct cyst (TGDC) is a congenital malformation in the neck. Surgical management is often recommended due to risk of recurrent infections and rare possibility of malignancy.Case ReportHerein, we describe the case of an adult presenting with tender neck mass and fever. She had a history of previous surgical excision of her TGDC as a child. On evaluation she was found to have a recurrent TGDC complicated by acute infection via computed tomography imaging.ConclusionIn patients who have had previous surgical intervention to remove a TGDC, recurrence with infection should remain a diagnostic consideration.

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

ObjectiveIdentify current trends, adverse events, and clinical predictors in children treated with thyroglossal duct cyst surgery. MethodsCross-sectional analysis using American College of Surgeons (ACS) National Surgical Quality Improvement Program® (ACS NSQIP® - pediatric), years 2012–2016. Patients were identified using CPT codes: 60280 - excision of thyroglossal duct cyst or sinus and 60281 - excision of thyroglossal duct cyst or sinus, recurrent. Results1532 (333 inpatient and 1199 outpatient) total cases were identified. Median age was 5.16 years interquartile range [IQR] (2.87, 8.35 years). No mortalities, cases of sepsis or nerve injury were identified. Adverse event rate was 4.4% (68/1532). Inpatient cases were associated with higher rates of adverse events (p = 0.006). Adverse events mostly consistent of wound infections, unplanned reoperations and readmissions, 2.6%, 2.2% and 2.0%, respectively. The most common unplanned reoperation was hematoma, seroma, or fluid drainage (0.59%). Median length of stay was 1 day, IQR (0, 1). An adjusted, multivariable logistic regression model revealed that the odds of adverse event rates for inpatient status were 101% higher than outpatients (odd ratio [OR] = 2.01; 95% CI = 1.20, 3.37; p = 0.008). ConclusionsThe most common adverse events were unplanned reoperations and readmissions. Outpatient surgery was most common and surgery for recurrent thyroglossal duct cysts was rare. Children selected for outpatient thyroglossal duct cyst surgery tended to be healthier and less medically complicated and may contribute to our observation of lower rates of adverse events compared to inpatients.

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

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. 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. 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. 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.

Recurrent thyroglossal duct cysts: a 15-year review of presentation, management and outcomes from a tertiary paediatric institution

Background: Primary management of thyroglossal duct cysts (TGDC) is the Sistrunk procedure, which aims to completely excise the cyst and associated duct. Recurrences are attributed to variable histopathology and inadequate excision of the duct and its branching ductules. We present a review of the presentation and management of recurrent TGDC over a 15-year period to assess trends and outcomes. Methods: Retrospective review of patients who underwent surgery for a TGDC at a tertiary paediatric hospital over a 15-year period. The following data was collected: age, sex, primary and subsequent presentations, histopathology, primary and subsequent operation reports and speciality of the primary operator. Results: Sixteen patients had a recurrent TGDC over the 15-year period. Six (37%) were male and 10 (63%) were female, with a mean age of 5.3±3.1 years. Initial management included Sistrunk procedure (11 cases, 68.75%), cystectomy (4 cases, 25%) and Schlange procedure (1 case, 6.25%). The mean time to recurrence was 20.7±26.9 months. Management of recurrences were Sistrunk (5 cases), revision Sistrunk (9 cases) or conservative management (2 cases). Two patients had three operations, without cure. Conclusions: Sistrunk procedure should be the primary management for TGDC. Patients who recurred after an initial limited surgical resection may be cured with subsequent Sistrunk procedure. Revision Sistrunk to manage recurrences following initial Sistrunk, had a high recurrence rate and two patients required two further operative interventions, both without cure. Research into the use of en bloc anterior neck dissection for the management of recurrent TGDC following Sistrunk in the paediatric population is suggested.

The Central Neck Dissection or the Modified Sistrunk Procedure in the Treatment of the Thyroglossal Duct Cysts in Children: Our Experience.

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.

Papillary carcinoma in a recurrent thyroglossal duct cyst

Thyroglossal duct carcinoma (TGDC) is a rare disease with many reported cases. The recurrence in such cases after surgical removal may be seen after cyst excision. Sistrunk’s operation is recommended, as it has a very low recurrence rate. The case which present as recurrence demonstrate histological pattern similar to a thyroglossal duct cyst. We present a case of recurrence of thyroglossal cyst, with a solid internal component on ultrasonography (USG). On histopathology the solid internal component proved to be papillary carcinoma. To our knowledge, our paper is the first case of recurrent thyroglossal cyst with a papillary carcinoma preoperatively suspected on USGBangladesh Journal of Medical Science Vol.16(1) 2017 p.166-169

The selective anterior neck dissection for treating children's recurrent thyroglossal duct cysts

Objective:To evaluate the therapeutic effect of selective anterior neck dissection on the treatment of children's recurrent thyroglossal duct cysts. Method: The clinical data of 28 patients with recurrent thyroglossal duct cysts were retrospectively analyzed. In accordance with the embryologic and anatomic features of thyroglossal duct cysts, different types of selective neck dissection were applied. Enbloc resection principles were applied to extirpate thyroglossal duct cysts,scarrings and inflammatory granuloma during the operation. Result:All the wounds of 28 patients healed primarily without significant complications including dysphagia, paragammacism, injury of hypoglossal nerve and superior laryngeal nerve. No recurrences were found in all 28 cases with a follow-up period of 24 to 72 months(average 46 months). Conclusion:Selective anterior neck dissection is a safe and effective surgical procedure for the radical treatment of children's recurrent thyroglossal duct cysts.

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

Thyroglossal duct cyst recurrence following resection is attributed to anatomical variability and residual thyroglossal ducts. In adults, thyroglossal duct cyst recurrence is extremely rare and a surgical solution is yet to be well explored. This paper describes our approach to the management of recurrent thyroglossal duct cysts and sinuses in adults using a wide anterior neck dissection. A retrospective review was performed to identify adults who underwent a wide anterior neck dissection for recurrent thyroglossal duct cyst management between 1 January 2009 and 1 January 2015. Six males and one female were included in the series (mean age, 26.4 ± 10.9 years). Recurrence occurred at a mean of 18 ± 9.8 months following primary surgical management (3 patients underwent cystectomy and 4 had a Sistrunk procedure). All patients subsequently underwent wide anterior neck dissection; there was no further recurrence over the 12-month average follow-up period. This paper describes a wide anterior neck dissection technique for the management of recurrent thyroglossal duct cysts or sinuses in adults; this approach addresses the variable anatomy of the thyroglossal duct and is associated with minimal morbidity.

Papillary Carcinoma in a Recurrent Thyroglossal Duct Cyst

Thyroglossal duct cyst is the most common developmental abnormality encountered in the neck. Carcinoma arising in a thyroglossal duct cyst is a rare occurrence, and was first reported by Ucherman in 1910, the most common being papillary carcinoma. The incidence of primary papillary carcinoma arising in thyroglossal duct cyst is less then1%. We report a case of papillary thyroid carcinoma occurring in a recurrent thyroglossal duct cyst in a 35 year old woman which was initially missed on fine needle aspiration cytology (FNAC), and subsequently diagnosed by histopathology. Though FNAC may aid in arriving at the diagnosis, it has limitations as in our case where carcinoma can be missed. Hence final pre-operative diagnosis should be combined with other diagnostic modalities. Key-words: FNAC, thyroglossal duct cyst, papillary carcinoma, histopathology

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

ObjectivesManagement 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. MethodsA 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. ResultsNine 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. ConclusionRecurrence 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.

“Extended” Sistrunk procedure in the treatment of recurrent thyroglossal duct cysts: A 10-year experience

ObjectiveWe report a 10-year experience of children with recurrent thyroglossal duct cysts (TGDCs) who have been treated using the “extended” Sistrunk procedure. MethodsWe 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. ResultsThere 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. ConclusionOur 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.

Failure of sclerotherapy in the treatment of thyroglossal duct cyst in children: 2 case reports and review of the literature

Thyroglossal duct cyst (TGDC) is one of most common congenital diseases of the midline of the neck. Most TGDC cases require treatment in the cases of cosmetic problems or recurrent infection, and a Sistrunk operation is considered to be the standard treatment. However, less invasive treatments are sometimes used, and sclerotherapy with OK-432 or ethanol is one such method. However, the validity or use of sclerotherapy as a TGDC treatment is controversial because cases of TGDC that have been successfully treated with sclerotherapy are rare, and the follow-up period is short, and there are no statistical reports about the reoccurrence of symptoms after sclerotherapy. In this report, we review 2 recurrent TGDC cases after sclerotherapy with OK-432 and ethanol and discuss the efficacy and limitations of sclerotherapy.

Cutaneous blisters as the presenting signs of recurrent thyroglossal duct cyst in a child

Conflict of interest: none declared. We report a 4‐year‐old boy who presented with a history of sudden onset of an asymptomatic mass, 25 mm in size, on the midline of the upper neck. High‐resolution ultrasonography (US) and magnetic resonance imaging could not confirm a precise diagnosis, but did indicate inflammation. Treatment with amoxicillin and clavulinic acid twice daily was started, but did not result in marked improvement. The mass was excised, and the histopathological findings were diagnostic for thyroglossal duct cyst associated with prominent inflammatory infiltrate. Serum levels of free thyroxine and thyroid‐stimulating hormone were normal. Three months later, two tense bullae, filled with a yellowish serum, developed at the scar site (Fig. 1a). The blisters burst several times after occasional trauma or during bathing, leaving a flaccid skin flap with the ostium of the fistula visible beneath it. The blisters rapidly refilled with serum, with a chronic course. Re‐excision of the whole lesion was carried out using the Sistrunk1 technique, i.e. including removal of the hyoid bone.

Recurrent thyroglossal duct cyst presenting as upper airway obstruction: A case presentation and review of the literature

Recurrent thyroglossal duct cyst presenting as upper airway obstruction: A case presentation and review of the literature

Recurrent thyroglossal duct cyst presenting as upper airway obstruction: A case presentation and review of the literature

Thyroglossal duct cysts are the most common congenital midline cervical masses in the pediatric population. Accurate preoperative diagnosis and subsequent adequate surgical excision are essential to prevent recurrence. The Sistrunk procedure is the surgical approach most often advocated. Although rare, treatment failure is most commonly attributed to the failure to perform adequate hyoid bone excision and dissection of the tract to the base of tongue. We report a case of a 7-year-old female who presented with airway obstruction 5 years after having had a Sistrunk procedure and excision of a lateral neck mass. Emergent tracheotomy and marsupialization of the base of tongue cyst were performed. After the diagnosis of recurrent thyroglossal duct cyst was established, core excision of the foramen cecum was performed transcervically when the cyst recurred a third time. The literature on recurrent thyroglossal duct cysts is reviewed and a discussion of its embryology, pathophysiology, epidemiology, presentation, treatment and prognosis is presented in an effort to increase awareness of this situation.

Obstructive lingual tonsil hypertrophy in recurrent thyroglossal duct cyst

The association between recurrent thyroglossal duct cyst (TGDC) and obstructive lingual tonsil hypertrophy has not previously been discussed. We present the case of a 7-year-old child whose medical and surgical course was complicated by these synchronous factors. The aim of this report is to present the risk factors for recurrence of TGDC and the unique challenge that concurrent lingual tonsil hypertrophy and airway obstruction present to management of patients.

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

We present an experience in the management of primary and recurrent thyroglossal duct cysts (TGDCs) and describe a novel method for recurrent TGDC removal. We performed a retrospective review of TGDC surgery at Children's Hospital in Seattle from 1980 to 2003. The surgical techniques for primary and recurrent TGDCs and the factors associated with TGDC recurrence were evaluated and analyzed. During the study period, 231 patients underwent 296 TGDC surgeries. Thirty-four of the 231 patients (15%) underwent a total of 88 procedures for recurrent TGDCs. Successful procedures used for secondary TGDC management included central neck dissection with directed base of tongue (BOT) excision in 6 of 9 patients (67%), secondary Sistrunk operation with limited BOT resection in 12 of 27 patients (44%), revision Sistrunk operation with BOT dissection in 7 of 11 patients (64%), and suture-guided transhyoid pharyngotomy in 8 of 8 patients (100%). Ten of the 231 patients (4%) had initial TGDC incision and drainage and then underwent a total of 21 procedures, excluding the incision and drainage. The factors associated with TGDC recurrence were inaccurate initial diagnosis (17 of 34 or 50%), infection (5 of 34 or 15%), unusual TGDC presentation (5 of 34 or 15%), and lack of BOT musculature removal (7 of 34 or 20%). The level of surgeon training affected the surgical outcome. Successful TGDC treatment requires consideration of factors associated with recurrence. Recurrent TGDCs can be treated by several methods, including suture-guided transhyoid pharyngotomy.

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

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

Central neck dissection for infected or recurrent thyroglossal duct cysts

Recurrence of clinically apparent thyroglossal duct cysts removed using the classic Sistrunk procedure exceeds 4%, even in skilled hands. When a thyroglossal duct cyst is infected at the time of surgery, the Sistrunk operation is unsuccessful in 40% of children. En bloc central neck dissection can reduce the risk of initial failure in difficult cases and adequately treat recurrent lesions.