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Investigation and treatment of thyroglossal cysts in children
C Brewis1, M Mahadevan, C M Bailey
1Great Ormond Street Hospital for Children, London, UK.
Insights
Thyroglossal duct cysts are common neck masses in children. Ultrasound and the Sistrunk procedure are recommended for best management, reducing recurrence and avoiding ectopic thyroid removal.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Surgical Practice Evaluation
Background:
- Thyroglossal duct cysts represent the most frequent midline neck masses encountered in pediatric patients.
- Current surgical practices for managing these cysts vary among specialists.
Purpose of the Study:
- To assess the current diagnostic and surgical management strategies for thyroglossal duct cysts in the UK.
- To identify optimal diagnostic and treatment protocols based on expert consensus and literature review.
Main Methods:
- A questionnaire survey was distributed to all Ear, Nose, and Throat (ENT) and pediatric surgeons across the UK.
- Response rate was 72%, providing data on investigation and surgical preferences.
- Published literature was reviewed to corroborate survey findings and establish best practices.
Main Results:
- Ultrasound was the most frequently requested investigation (54%).
- A modified Sistrunk's procedure was the most common surgical intervention (78%).
- Pediatric surgeons performed fewer investigations but excised more of the thyroglossal tract compared to ENT surgeons.
Conclusions:
- Ultrasound imaging and the Sistrunk procedure are identified as the optimal management policy for thyroglossal duct cysts.
- This approach aids in avoiding inadvertent removal of ectopic thyroid tissue and minimizes cyst recurrence.
Abstract:
Thyroglossal cysts are the commonest midline neck masses in children. To evaluate current practice questionnaires were sent to all ear, nose and throat (ENT) and paediatric surgeons in the UK and 72% responded. The commonest investigation requested was an ultrasound scan (54%) and the commonest operation was a variant of Sistrunk's procedure (78%). Paediatric surgeons did fewer investigations than ENT surgeons and tended to excise more of the thyroglossal tract. Review of the published work suggests that ultrasound scanning and Sistrunk's procedure are the best management policy. The scan can avoid inadvertent excision of an ectopic thyroid gland. Extensive thyroglossal tract excisions give lower recurrence rates.