Abstract
Although Sistrunk operation is the standard method to treat thyroglossal duct cyst, the reported recurrence rates after a “classic” or “modified” Sistrunk procedure still varied from 0 to 15.8 %, indicating the existence of some technical uncertainties. While simple cystectomy has been recognized as the most important prognostic factor predicting thyroglossal duct cyst recurrence, whether other clinico-pathological parameters also affect disease recurrence has not been well studied. We retrospectively reviewed the medical records of all patients who underwent thyroglossal duct cyst surgery between June 1998 and June 2014 at our institution. Among the 180 primary patients, 160 patients received a “conservative” Sistrunk operation, while the remaining 20 patients received simple cystectomy only. Five patients (2.8 %, 5/180) had recurrence. Four of them received simple cystectomy while 1 had “conservative” Sistrunk operation. In univariable analysis, age (p = 0.02), history of previous infection (p = 0.004) and the type of resection (p = 0.001) were significantly correlated with disease recurrence. In multivariable analysis, the type of resection turned out to be the most important factor (p = 0.03) related to recurrence. In the most parsimonious model selected by backward elimination, both history of infection (p = 0.048) and the type of resection (p = 0.02) were important predictors of postoperative recurrence. Our results demonstrated that a “conservative” Sistrunk approach could provide a comparably low recurrence rate (0.6 %, 1/160) in dealing with primary thyroglossal dust cysts. Routine dissection of suprahyoid tissue may not be imperative. Overall, the type of resection and history of infection are the most important predictors of recurrence for thyroglossal duct cyst.
Similar content being viewed by others
References
Simon LM, Magit AE (2012) Impact of incision and drainage of infected thyroglossal duct cyst on recurrence after Sistrunk procedure. Arch Otolaryngol Head Neck Surg 138(1):20–24
Moore KL, Persaud TVN, Torchia MG (2013) The developing human: clinically oriented embryology, 9th edn. Saunders/Elsevier, Philadelphia
Sadler TW, Langman J (2012) Langman’s medical embryology, 12th edn. Wolters Kluwer Health/Lippincott Williams and Wilkins, Philadelphia
Sistrunk WE (1920) The surgical treatment of cysts of the thyroglossal tract. Ann Surg 71:121–122
Horisawa M, Niinomi N, Nishimoto K, Matsunaga K, Ogura Y, Watanabe Y, Ando H (1999) Clinical results of the shallow core-out procedure in thyroglossal duct cyst operation. J Pediatr Surg 34(11):1589–1592
Kim MK, Pawel BR, Isaacson G (1999) Central neck dissection for the treatment of recurrent thyroglossal duct cysts in childhood. Otolaryngol Head Neck Surg 121(5):543–547
Patel NN, Hartley BE, Howard DJ (2003) Management of thyroglossal tract disease after failed Sistrunk’s procedure. J Laryngol Otol 117(9):710–712
Perkins JA, Inglis AF, Sie KC, Manning SC (2006) Recurrent thyroglossal duct cysts: a 23-year experience and a new method for management. Ann Otol Rhinol Laryngol 115(11):850–856
Maddalozzo J, Alderfer J, Modi V (2010) Posterior hyoid space as related to excision of the thyroglossal duct cyst. Laryngoscope 120(9):1773–1778
Koempel JA (2014) Thyroglossal duct remnant surgery: A reliable, reproducible approach to the suprahyoid region. Int J Pediatr Otorhinolaryngol 78(11):1877–1882
Geller KA, Cohen D, Koempel JA (2014) Thyroglossal duct cyst and sinuses: a 20-year Los Angeles experience and lessons learned. Int J Pediatr Otorhinolaryngol 78(2):264–267
de Tristan J, Zenk J, Künzel J, Psychogios G, Iro H (2014) Thyroglossal duct cysts: 20 years’ experience (1992–2011). Eur Arch Otorhinolaryngol (Epub ahead of print)
Rohof D, Honings J, Theunisse HJ, Schutte HW, van den Hoogen FJ, van den Broek GB, Takes RP, Wijnen MH, Marres HA (2014) Recurrences after thyroglossal duct cyst surgery: results in 207 consecutive cases and review of the literature. Head Neck. doi:10.1002/hed.23817 (Epub ahead of print)
Yazdi AK, Sazgar AA, Noviri BB, Mahboubi H, Mojtahed M (2011) The role of pre-operative infection in the recurrence of thyroglossal duct cyst. B-ENT 7(3):169–171
Shah R, Gow K, Sobol SE (2007) Outcome of thyroglossal duct cyst excision is independent of presenting age or symptomatology. Int J Pediatr Otorhinolaryngol 71(11):1731–1735
Ohta N, Fukase S, Watanabe T, Ito T, Kubota T, Suzuki Y, Aoyagi M (2012) Treatment of thyroglossal duct cysts by OK-432. Laryngoscope 122(1):131–133
Bennett KG, Organ CH Jr, Williams GR (1986) Is the treatment for thyroglossal duct cysts too extensive? Am J Surg 152(6):602–605
Ducic Y, Chou S, Drkulec J, Ouellette H, Lamothe A (1998) Recurrent thyroglossal duct cysts: a clinical and pathologic analysis. Int J Pediatr Otorhinolaryngol 44:47–50
Hussain K, Henney S, Tzifa K (2013) A ten-year experience of thyroglossal duct cyst surgery in children. Eur Arch Otorhinolaryngol 270(11):2959–2961
Ren W, Zhi K, Zhao L, Gao L (2011) Presentations and management of thyroglossal duct cyst in children versus adults: a review of 106 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 111(2):e1–e6
Lin ST, Tseng FY, Hsu CJ, Yeh TH, Chen YS (2008) Thyroglossal duct cyst: a comparison between children and adults. Am J Otolaryngol 29(2):83–87
Horisawa M, Niinomi N, Ito T (1992) What is the optimal depth for core-out toward the foramen cecum in a thyroglossal duct cyst operation? J Pediatr Surg 27(6):710–713
Ahmed J, Leong A, Jonas N, Grainger J, Hartley B (2011) The extended Sistrunk procedure for the management of thyroglossal duct cysts in children: how we do it. Clin Otolaryngol 36(3):271–275
Ubayasiri KM, Brocklehurst J, Judd O, Beasley N (2013) A decade of experience of thyroglossal cyst excision. Ann R Coll Surg Engl 95(4):263–265
Pastore V, Bartoli F (2014) “Extended” Sistrunk procedure in the treatment of recurrent thyroglossal duct cysts: a 10-year experience. Int J Pediatr Otorhinolaryngol 78(9):1534–1536
Lee DH, Yoon TM, Lee JK, Lim SC (2012) Is fine needle aspiration cytology appropriate for preoperatively diagnosing thyroglossal duct cysts in children under the age of 10 years? Int J Pediatr Otorhinolaryngol 76(4):480–482
Lee DH, Jung SH, Yoon TM, Lee JK, Joo YE, Lim SC (2013) Preoperative computed tomography of suspected thyroglossal duct cysts in children under 10-years-of-age. Int J Pediatr Otorhinolaryngol 77(1):45–48
Hirshoren N, Neuman T, Udassin R, Elidan J, Weinberger JM (2009) The imperative of the Sistrunk operation: review of 160 thyroglossal tract remnant operations. Otolaryngol Head Neck Surg 140(3):338–342
Huoh KC, Durr ML, Meyer AK, Rosbe KW (2012) Comparison of imaging modalities in pediatric thyroglossal duct cysts. Laryngoscope 122(6):1405–1408
Ali AA, Al-Jandan B, Suresh CS, Subaei A (2013) The relationship between the location of thyroglossal duct cysts and the epithelial lining. Head Neck Pathol 7(1):50–53
Pellegriti G, Lumera G, Malandrino P, Latina A, Masucci R, Scollo C, Spadaro A, Sapuppo G, Regalbuto C, Pezzino V, Vigneri R (2013) Thyroid cancer in thyroglossal duct cysts requires a specific approach due to its unpredictable extension. J Clin Endocrinol Metab 98(2):458–465
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical standard
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study protocol was reviewed and approved by the Institutional Human Experiment and Ethic Committee (A-ER-103-102). For this type of study (retrospective chart review), formal consent is not required.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zhu, YS., Lee, CT., Ou, CY. et al. A 16-year experience in treating thyroglossal duct cysts with a “conservative” Sistrunk approach. Eur Arch Otorhinolaryngol 273, 1019–1025 (2016). https://doi.org/10.1007/s00405-015-3571-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-015-3571-3