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Reoperation for cysts of the thyroglossal duct
H Flageole1, J M Laberge, L T Nguyen
1Department of Surgery, Montreal Children's Hospital, Que.
Insights
Thyroglossal duct cysts (TDCs) often recur after simple cystectomy without hyoidectomy or if initially infected. The Sistrunk operation is effective in managing recurrent TDCs.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Surgical Pathology
Background:
- Thyroglossal duct cysts (TDCs) are congenital anomalies that can lead to recurrent infections and complications.
- Understanding the factors contributing to TDC recurrence is crucial for optimizing treatment strategies.
Purpose of the Study:
- To identify the primary causes of thyroglossal duct cyst recurrence in pediatric patients.
- To evaluate the effectiveness of different surgical interventions for TDC management.
Main Methods:
- A retrospective case series involving 121 children treated for TDCs between 1974 and 1990.
- Analysis of initial procedures, recurrence rates, and outcomes following various surgical interventions, including simple cystectomy and the Sistrunk operation.
Main Results:
- Recurrence rates were significantly higher in TDCs that were initially infected (40%) compared to non-infected cysts (8%).
- Simple cystectomy without hyoidectomy was associated with recurrence, whereas the Sistrunk operation proved effective in managing recurrent cases.
- Three cases of recurrence were observed even after the Sistrunk operation in non-infected cysts.
Conclusions:
- Incomplete excision (simple cystectomy without hyoidectomy) and pre-existing infection are significant risk factors for TDC recurrence.
- The Sistrunk operation is a definitive treatment for recurrent thyroglossal duct cysts.
Objective:
To determine the causes of recurrence of thyroglossal duct cysts (TDCs).
Design:
A case series.
Setting:
A university-affiliated children's hospital.
Patients:
Between 1974 and 1990, 121 children were treated for TDCs. They ranged in age from 1 month to 18 years. Of these 121 children, 23 had recurrent TDC.
Interventions:
Simple aspiration of the cyst, incision and drainage, cystectomy without hyoidectomy and the Sistrunk operation.
Main Outcome Measures:
Initial procedures that led to recurrence and procedures that resulted in cure.
Results:
Six children had recurrence of TDCs after simple cystectomy without hyoidectomy; all were cured by the Sistrunk operation. Fourteen children with infected cysts initially underwent a variety of procedures with recurrence and were eventually managed by the Sistrunk operation. TDCs recurred in eight of these. Three children without infected cysts had recurrence after the Sistrunk operation. Of 34 TDCs infected initially, 40% recurred, whereas of 87 TDCs that were not infected initially, only 8% recurred.
Conclusion:
Simple cystectomy without hyoidectomy and pre-existing infection are the main causes of recurrence of TDCs.