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

Abstract

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.

Does thyroglossal duct arborization play a role in the post-surgical outcome of Sistrunk procedure in children?

“…The recurrence rate after the original Sistrunk procedure was around 1–5%; therefore in 1928, Sistrunk [ 12 ] himself modified his original technique to include the lingual muscle up to (but not including) the tongue mucosa. The modified Sistrunk procedure remains the gold standard treatment for symptomatic TGDC [ 18 ].…”

Thyroglossal duct cyst as a cause of dyspnea in a two-year-old child

“…Most thyroglossal duct cysts manifest following upper respiratory tract infections or secondary to their inflammation. Treatment should be commenced with broad-spectrum antibiotics targeting the oral cavity's flora and subsequently concluded with Sistrunk's operative procedure [20,21]. Operating in an infectious episode is contraindicated due to the high risk of recurrence of the lesion [22,23].…”