Predictors of Thyroglossal Duct Cyst Recurrence and Complications Following Sistrunk Procedure

Recurrence is the primary complication of the Sistrunk procedure performed for the resection of thyroglossal duct cysts (TGDC). We aim to more confidently identify patients who may be predisposed to recurrence or other postoperative complications based on their clinical presentation and (or) perioperative course.

Our institution's electronic medical record was queried over a 23-year period (2000-2023) for patients with TGDC who underwent a Sistrunk procedure. Demographics, clinical presentation, and outcomes data were collected and analyzed. The primary outcome was the factors associated with postoperative TGDC recurrence. The secondary outcomes were the factors associated with Sistrunk procedure complications.

A total of 357 patients underwent a Sistrunk procedure for TGDC at a mean age of 5.75 years and an average duration of follow-up of 26.5 months. Age, gender, race, cutaneous tracts, tongue base findings, pre-operative infection, number of pre-operative infections, incision and drainage, needle aspiration, placement of a post-operative drain, and the type of drain placed were unassociated with recurrence. The two factors associated with recurrence were postoperative infection (adjusted OR = 11.98 [95% CI: 3.38, 42.49], p = < 0.001) and postoperative seroma (adjusted OR = 5.03 [95% CI: 1.17, 21.62], p = -0.030). Male sex was significantly associated with postoperative complications (adjusted OR = 3.26 [95% CI: 1.55, 6.89], p = 0.002).

Recurrence of TGDC after a Sistrunk procedure is an ongoing challenge that occurs in approximately 5% of cases. Recurrence is likely due to two factors: inadequate surgical technique and (or) histological factors like remnant arborizing microscopic ductules. Postoperative infection and seroma do not cause recurrence but may be predictors of residual disease due to one of these two factors and warrant closer surveillance.