Central neck dissection for the treatment of recurrent thyroglossal duct cysts in childhood

Abstract

OBJECTIVE: The recurrence rate of thyroglossal duct cysts removed by the classic Sistrunk procedure exceeds 4%, even in skilled hands. Simple reexcision fails in 33% of these patients. Recent pathology literature suggests that the tracts of thyroglossal duct cysts may arborize, arguing for a wide-field approach to recurrent lesions. We describe the anatomic rationale and technique of an en bloc central neck dissection in children, on the basis of cadaver dissections and histopathologic review of recurrent thyroglossal duct cyst specimens. METHODS: We reviewed the medical records of all the children undergoing surgery for thyroglossal duct cysts and fistulas during the years 1990 to 1998 by the senior author. En bloc central neck dissections were performed on several cadaver specimens to further delineate the anatomic rationale for this procedure. RESULTS: We have performed an en bloc central neck dissection in 7 children, 5 with recurrent or multiply recurrent thyroglossal duct cysts. None has had a recurrence after follow-up of 9 months to 6 years. All have acceptable functional and cosmetic results. CONCLUSION: An en bloc central neck dissection is a logical and effective surgical technique for the removal of recurrent or multiply recurrent thyroglossal duct cysts.

Thyroglossal duct cysts: presentation and management in children versus adults

“…In our series, two patients originally treated at our institution with a Sistrunk operation developed a recurrence. In recalcitrant cases, the surgeon should consider further dissection of the neck to remove all tract remnants [26].…”

Core excision of the foramen cecum for recurrent thyroglossal duct cyst after sistrunk operation

“…4 Another option is en bloc central neck dissection for removal of recurrent or multiply recurrent TGDC. 5 The patient described here had initially undergone what appeared to be an adequate Sistrunk operation. Neither ultrasonography nor magnetic resonance imaging (MRI) were helpful in identifying a remnant tract or cyst.…”

“…3 The solutions offered in the literature range from wider and deeper excision (to include epithelial remnants that may have deviated from the midline) 4 to en bloc central neck dissection. 5 However, there is a lack of direction in the literature if the above-mentioned procedures fail. We successfully performed a core excision of the foramen cecum in a patient with recurrent TGD cyst after the classic Sistrunk operation and anterior cervical dissection had failed.…”

Obstructive lingual tonsil hypertrophy in recurrent thyroglossal duct cyst

“…In 1983, Mickel and Calcaterra [7] described success with an en bloc operation for recurrent TGDCs. The anatomical basis and rationale of central neck dissection were described by Kim et al [8] in 1999. The dissection extends from the upper edge of the thyroid gland to the foramen cecum and along the plane of the pretracheal fascia, removing the specimen en bloc.…”