A novel surgical technique for the management of recurrent thyroglossal duct cysts using Dakin's solution packing

The aim of this study is to evaluate the risk factors for thyroglossal duct cyst (TGDC) recurrence after the Sistrunk procedure and to report our experience with Dakin's solution (DS) packing as a novel surgical technique for managing recurrent TGDCs.

A retrospective chart review was performed of patients younger than 18 years who underwent a modified Sistrunk procedure. Collected data included age, sex, history of cutaneous sinus tract and incision and drainage, infections, trainee presence, procedures for managing primary and recurrent TGDC, recurrence, length of hospital stay, readmission and complications.

A total of 150 patients with a median age of 5.46 years who underwent a modified Sistrunk procedure were included. Twelve (8.0%) patients had recurrence. Univariate analysis revealed increased recurrence risk with a history of cutaneous sinus tract and infections prior to Sistrunk and decreased risk with trainee presence during Sistrunk (p < 0.05). While controlling for the remainder of factors, history of cutaneous sinus tract continued to show increased odds of recurrence (p < 0.05). Eight patients with a median age of 6.78 years received DS packing for management of recurrent TGDC. The median duration of packing changes and length of hospital stay was 14 and 2.5 days, respectively. One readmission and no recurrences were observed after patients received DS packing. No other complications attributable to DS packing were observed.

History of a cutaneous sinus tract was associated with an increased risk of TGDC recurrence on multivariate analysis. This study supports the feasibility and preliminary safety of DS packing as a modality for treating recurrent TGDCs. Larger prospective studies are needed to determine efficacy and safety, as well as to identify the patient subgroups most likely to benefit from this intervention.