Head and Neck Endocrine Surgery in Children

Abstract

Objectives: To characterize children undergoing parathyroid, thyroid, and thyroglossal duct cyst surgery in 1997 and 2000 using a nationally representative discharge database to determine whether rates and outcomes of these surgical treatments vary by age, sex, and health care system attributes. Data Source: The 1997 and 2000 Kids' Inpatient Database, available through the Agency for Healthcare Research and Quality. Study Selection: All patients 18 years and younger undergoing head and neck endocrine (HNE) procedures were included. Data Extraction: The sampling scheme of this database allowed for calculation of national and regional estimates using Stata 7.0. Data Synthesis: An estimated 2077 and 1871 inpatient pediatric HNE procedures were performed nationally in 1997 and 2000, respectively. Most were performed at general (nonpediatric) teaching hospitals. There were an estimated 1102 thyroglossal duct cyst excisions, making this the most common HNE procedure and diagnosis. Thyroid lobectomy was the second most common HNE surgical treatment. Thyroid malignant neoplasm (usually treated by total thyroidectomy) was the second most common diagnosis. Neck dissections were performed in 32% of patients with thyroid malignant neoplasm. These HNE procedures accounted for more than $28 million in hospital charges in 1997 and nearly $38 million in 2000. Conclusions: Surgical treatment trends for pediatric HNE procedures remained stable between 1997 and 2000. Thyroglossal duct cyst excision and thyroid lobectomy are the most common procedures. There were regional differences in the rates of most HNE surgical treatments. In addition, hospital charges increased between 1997 and 2000.

Obstructive lingual tonsil hypertrophy in recurrent thyroglossal duct cyst

“…Similarly, TGDC excision is the most common pediatric head and neck procedure performed [1]. Under typical circumstances, the thyroglossal duct becomes thinner and longer during embryologic descent, and ultimately the lumen disappears.…”

Thyroglossal Duct Anomalies in Pediatric and Adult Population: A 10-Year Experience in a Tertiary Care Hospital

“…The other differentials included for such a swelling are dermoid cyst, branchial cyst, ectopic thyroid tissue, hemangioma, and neck lymph nodes [2]. Thyroglossal duct cyst has also been associated with median ectopic thyroid tissue, but only 1% or less of these have been associated with occult thyroid malignancy [3].…”

“…Due to the high rate of infection in these cysts it is not uncommon (1/3 rd ) to find patients either with a history of prior infections or having one. [3] The definitive treatment for thyroglossal duct cyst is complete surgical excision along with its tract (Sistrunk procedure) as described by W.E. Sistrunk [4] [5] in 1920.…”

“…The procedure entails removal of cyst followed with excision of its tract up to hyoid bone and completed by removing a muscular cuff around tongue base (the embryologic pathway of descent) [5]. Though postoperative complications are rare, recurrence is a major unwarranted sequela of the surgical intervention [3].…”

Why Central Neck Dissection Works (and Fails) for Recurrent Thyroglossal Duct Remnants

“…Thyroglossal duct cysts remain a source of frustration to surgeons who manage this most frequent of congenital cervical malformations. 1 Despite a century of experience with Walter Sistrunk's elegant procedure, 5% to 10% of expertly performed surgeries result in recurrent neck infection and/or persistent fistulization. Several authors have offered modifications to address the weaknesses of the Sistrunk approach.…”