The incidence of microscopic thyroglossal duct tissue superior to the hyoid bone

Garcia, Erick; Osterbauer, Beth; Parham, David M.; Koempel, Jeffrey A.

doi:10.1002/lary.27291

Cited by 21 publications

(22 citation statements)

References 17 publications

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“…The thyroglossal duct is the portion of the tract that remains connected to the base of the tongue after thyroid gland descent and is thought to involute at 7–10 weeks gestation. Persistence of portions of the thyroglossal duct can lead to formation of thyroglossal duct cysts (TGDCs), remnants, or tracts [1, 2]. The prevalence of TGDCs is thought to be roughly 7% of the population, with 1% of those developing into TGDC carcinoma.…”

Section: Introductionmentioning

confidence: 99%

Thyroglossal Duct Cyst Carcinoma in a Young Female: Case Report and Review of Literature

Beck

Zhan

2019

Case Reports in Otolaryngology

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Thyroglossal duct remnants form during embryologic development and can develop into a thyroglossal duct cyst (TGDC). In rare cases, carcinoma is present within these cysts, most commonly papillary thyroid carcinoma. Diagnosis is difficult, but imaging and fine-needle aspiration (FNA) biopsies can help with the diagnosis. Given the rarity of TGDC carcinoma, treatment is not well agreed upon and can include the Sistrunk procedure, thyroidectomy, nodal dissection, and postoperative radioactive iodine treatment. Here, we describe the presentation, workup, and treatment of a 20-year-old female with papillary thyroid carcinoma present within both a thyroglossal duct cyst and the thyroid gland.

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Section: Introductionmentioning

confidence: 99%

Thyroglossal Duct Cyst Carcinoma in a Young Female: Case Report and Review of Literature

Beck

Zhan

2019

Case Reports in Otolaryngology

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“…This raises anxiety for the patient, parent, and surgeon, in addition to a resultant increase in healthcare costs. The suprahyoid area is particularly relevant to the TGDC surgeon because there often exists single or multiple microscopic ducts and/or aborization of the tract, none of which can be visualized or palpated by the surgeon and therefore may not be excised during a primary procedure 5,7,8–10 . In this study, a large majority, 79% (37 of 47) of patients, had evidence of microscopic TDGC disease in the area superior to the hyoid.…”

Section: Discussionmentioning

confidence: 78%

“…Unlike the perihyoid area, where the hyoid bone serves as an easily identifiable surgical landmark, there are no obvious surgical landmarks in the suprahyoid area. Garcia et al have shown that microscopic disease was present superior to the hyoid bone in 74% of all cases and in 100% of revision cases 7 . These data underscore the importance of complete removal of TGDC superior to the hyoid in order to avoid persistent or recurrent disease and a revision procedure.…”

Section: Introductionmentioning

confidence: 90%

The Relevance of and Surgical Approach to the Suprahyoid Region in Thyroglossal Duct Surgery

et al. 2020

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Objectives Persistent or recurrent disease following excision of a thyroglossal duct cyst/sinus (TGDC) is often found in the suprahyoid region. Cadaver dissections were performed to identify and name important surgical landmarks in the suprahyoid area; a histopathologic analysis of surgical specimens was completed to determine the incidence and extent of microscopic disease; and clinical outcomes were compared to determine the efficacy of a specific anatomic dissection. Study Design Retrospective case series. Methods Standardized dissections of four adult cadavers were performed. Consecutive surgical specimens were examined for evidence of microscopic TDGC disease in the suprahyoid region, measuring the greatest width and length of disease. A retrospective review of all consecutive TGDC procedures was completed. Results The important surgical landmarks in the suprahyoid area were identified in all cadavers. Microscopic disease in the suprahyoid area was found in 79% (37 of 47) of surgical specimens. The mean greatest length and width of microscopic disease was 12.4 mm and 1.4 mm, respectively. Following identification of these landmarks, the incidence of recurrent or persistent disease decreased (P = .02) from 5% (8 of 159) to 0% (0 of 112). Conclusion The majority of pediatric patients with a TGDC will have microscopic disease in the suprahyoid area. The surgical landmark of the fascial plane between the geniohyoid and genioglossus muscles demarcates the anterior and lateral borders of resection in the suprahyoid area. This approach can be used as a reliable and easily reproducible technique in TGDC surgery to increase confidence of achieving complete removal of disease in the suprahyoid area, avoiding persistent or recurrent disease and a revision procedure. Level of Evidence 4 Laryngoscope, 131:553–558, 2021

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“…Despite these advances in our understanding of the anatomy of thyroglossal remnants and improvements in dissection of the infrahyoid and posterior hyoid components, dissection between the hyoid and foramen cecum remains the final frontier. Garcia et al 28 studied serial pathology sections and found microscopic evidence of suprahyoid disease in 74% of primary TGDR resections and 100% of revision cases. Sistrunk had recognized that it was difficult to follow the thyroglossal duct tract above the hyoid.…”

Section: Discussionmentioning

confidence: 99%

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

Isaacson

Kaplon

Tint

2019

Ann Otol Rhinol Laryngol

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Objective: To review the patient characteristics and outcomes for children and undergoing central neck dissection for control of recurrent thyroglossal duct cysts and fistula following prior Sistrunk procedures and children requiring surgery for refractory infection. Methods: We performed a computerized review of all children who were evaluated for thyroglossal duct cysts during the years 1999-2018 by a single surgeon operating at an urban children’s hospital and an outpatient surgical center. Those requiring a central neck dissection for control of recurrent disease or intractable infection were identified. Age at time of surgery, sex, surgical procedure, and postoperative complications were recorded. These data were combined with similar data from a published report by the same surgeon in the years 1990-1998 to complete a 28-year review. Results: 18 central neck dissections were performed including 13 for recurrent thyroglossal duct remnants after Sistrunk procedures and 5 primary surgeries for intractable infection. Ages ranged from 3 to 19 years (median = 10 years) and 13 of 18 were girls (72%). Four children had their first Sistrunk surgery performed by the senior author. Three children operated elsewhere had intact hyoid bones at the time of revision surgery, suggesting less-than-Sistrunk primary surgeries. Central neck dissection controlled disease in the lower neck in all cases. One child re-fistulized at the level of the hyoid. Conclusions: Central neck dissection in combination with a Sistrunk-type dissection of the tongue base is effective in the control of recurrent infection following unsuccessful Sistrunk surgery and aids in dissection for children with intractable infection. Although this technique reliably controls infrahyoid disease and improves access to the hyoid and posterior hyoid space, it does nothing to address the difficulties of following the thyroglossal tract into the tongue base.

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The incidence of microscopic thyroglossal duct tissue superior to the hyoid bone

Abstract: 2b. Laryngoscope, 2018.

Cited by 21 publications

References 17 publications

Thyroglossal Duct Cyst Carcinoma in a Young Female: Case Report and Review of Literature

Thyroglossal Duct Cyst Carcinoma in a Young Female: Case Report and Review of Literature

The Relevance of and Surgical Approach to the Suprahyoid Region in Thyroglossal Duct Surgery

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

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