Article Abstract

Recurrent thyroglossal duct cysts: a 15-year review of presentation, management and outcomes from a tertiary paediatric institution

Authors: Luke M. O’Neil, Alan T. Cheng

Abstract

Background: Primary management of thyroglossal duct cysts (TGDC) is the Sistrunk procedure, which aims to completely excise the cyst and associated duct. Recurrences are attributed to variable histopathology and inadequate excision of the duct and its branching ductules. We present a review of the presentation and management of recurrent TGDC over a 15-year period to assess trends and outcomes.
Methods: Retrospective review of patients who underwent surgery for a TGDC at a tertiary paediatric hospital over a 15-year period. The following data was collected: age, sex, primary and subsequent presentations, histopathology, primary and subsequent operation reports and speciality of the primary operator.
Results: Sixteen patients had a recurrent TGDC over the 15-year period. Six (37%) were male and 10 (63%) were female, with a mean age of 5.3±3.1 years. Initial management included Sistrunk procedure (11 cases, 68.75%), cystectomy (4 cases, 25%) and Schlange procedure (1 case, 6.25%). The mean time to recurrence was 20.7±26.9 months. Management of recurrences were Sistrunk (5 cases), revision Sistrunk (9 cases) or conservative management (2 cases). Two patients had three operations, without cure.
Conclusions: Sistrunk procedure should be the primary management for TGDC. Patients who recurred after an initial limited surgical resection may be cured with subsequent Sistrunk procedure. Revision Sistrunk to manage recurrences following initial Sistrunk, had a high recurrence rate and two patients required two further operative interventions, both without cure. Research into the use of en bloc anterior neck dissection for the management of recurrent TGDC following Sistrunk in the paediatric population is suggested.