Management of thyroglossal tract disease after failed Sistrunk’s procedure

Abstract

Sistrunk's procedure for thyroglossal duct remnants has a very high success rate, there remains the occasional patient, however, that will have recurrent disease despite a competently performed operation. Applied anatomy and embryology proffer a solution to this problem. Extending the Sistrunk operation, with an anterior wide local excision remaining within normal tissue, enables removal of the entire thyroglossal tract remnant.A retrospective case note review was conducted to study our experience using this extended procedure to treat patients with thyroglossal tract disease that had recurred after a previous Sistrunk's operation.Six patients aged from ve to 33 years were included in the study. There was one recurrence and the complication rate was comparable to the standard operation.It was concluded that a wide local excision is a valuable extension of the Sistrunk operation for the management of recurrent disease.

Management of Thyroglossal Duct Cysts After Failed Sistrunk Procedure

“…Several descriptions of extending the Sistrunk procedure-taking an additional core of the tongue base and performing a central neck dissection-have been suggested to prevent or treat recurrent lesions. 5,6,7 We found identification of the hypoglossal nerve to be an important step in three patients (Fig. 2).…”

Uncommon thyroglossal duct cyst with inward tendency: A recommendation regarding ingrowth type

“…The Sistrunk procedure for TDC results in a high cure rate, but rarely, a patient may present subsequent recurrence despite a competently performed operation, if the local excision is not sufficiently wide [22]. However, wide local excision of TDC is not always suitable for infants who are less than 2 years old [23] because the Sistrunk procedure, for ingrowth TDC without a projecting mass, sometimes results in excessive trauma. Previously, there were alternative procedures for ingrowth TDC (e.g., marsupialization or endoscopic complete excision), which may have been more effective than Sistrunk surgery in treating infants with a huge lingual TDC [24,25].…”

Thyroglossal Duct Cysts

“…Reoperation should focus on wider and deeper removal of midline fascial tissue involving the area of recurrence [27]. This will help to ensure that any previously missed tracts have been resected.…”