Transoral endoscopic approach for thyroglossal duct cysts in pediatric patients: Technique, safety, and feasibility

The Sistrunk procedure for thyroglossal duct cyst (TGDC) resection leaves a visible neck scar. Transoral endoscopic approaches offer potential cosmetic advantages, but pediatric data remain limited. This study evaluated the feasibility, safety, and outcomes of a modified transoral endoscopic vestibular approach for pediatric TGDC.

We retrospectively review 20 pediatric patients undergoing TGDC resection between November 2023 and October 2024. Seven underwent transoral endoscopic vestibular resection (gasless technique with unilateral oral distractor and mental nerve preservation), and 13 underwent transcervical Sistrunk procedure. Outcomes including operative details and cosmetic satisfaction were compared.

All transoral procedures were completed without conversion. Operative time (230.7 ± 32.3 vs. 80.0 min, p < 0.05) and hospital stay (3.9 ± 0.4 vs. 2.0 days) were significantly longer in the transoral group. One patient (14.3%) experienced transient mental nerve paresis resolving by 6 months; one transcervical patient (7.7%) developed seroma. Cosmetic satisfaction was significantly higher in the transoral group (VAS 9.9 ± 0.4 vs. 6.0 at 12 months, p < 0.01).

Transoral endoscopic vestibular resection of pediatric TGDC is technically feasible with superior cosmetic satisfaction compared to transcervical excision, despite longer operative time and hospitalization. Strict adherence to the 'safety zone between the mandibular canines' minimizes mental nerve injury. These preliminary findings require validation in larger cohorts.