Iatrogenic pneumomediastinum followed by bilateral pneumothoraces: A case report

Major respiratory catastrophe associated with iatrogenic airway injury during the Sistrunk operation is a rare event. A three-year-old patient underwent thyroglossal duct cyst removal under general anaesthesia. An iatrogenic thyroid cartilage injury occurred in the intraoperative period, and it was repaired primarily. Later, in the post-anaesthesia care unit, the patient developed subcutaneous emphysema in the neck and face, and then pneumomediastinum and bilateral pneumothoraces. The patient was managed with bilateral chest drains and endotracheal intubation, and he required mechanical ventilation for three days. So, even after repair of a recognised iatrogenic airway injury associated with the Sistrunk operation, it may be necessary to continue positive pressure ventilation in the postoperative period to avoid serious respiratory complications.

Thyroglossal duct cyst variation in presentation: our experience of 3 years

Background: The prime objective of the present study was, to learn incidence of thyroglossal duct cyst in different age and sex groups and variation in its presentation.Methods: The present retrospective study was carried out in department of otorhinolaryngology and head and neck surgery, GMC Jammu from June 2017 to May 2020. In this retrospective study clinical records, medical records and histopathological records were thoroughly reviewed and studied. 20 patients diagnosed as thyroglossal duct cyst were included in the present study.Results: Out of 20 patients, 14 were paediatric patients and 6 were adults. 15 patients presented with cystic swelling while 5 patients presented with fistula. Out of 20 patients, 5 patients had suprahyoid presentation, 4 patients had cyst at the level of hyoid and 11 had infrahyoid presentation. 16 patients underwent sistrunk operation while 4 patients underwent simple excision. Out of 4 patients who had undergone simple excision, 2 patients developed recurrence.Conclusions: In the present study it is concluded that paediatric age group presents most commonly with thyroglossal cyst as a midline, painless swelling. The most common site observed is infrahyoid region. After proper investigations and diagnosis, thyroglossal duct cyst should be excised preferably by sistrunk operation.

RECURRENCE OF THYROGLOSSAL DUCT CYST AFTER SISTRUNK OPERATION.

Introduction: Thyroglossal duct cyst (TGDC) is the most common form of congenital anomaly in the head and neck region with prevalence of 7%. Embryologically the thyroglossal duct tract gets atrophied by fifth to tenth week of gestation. If it does not atrophied it results in TGDC and operation is the treatment of choice. However, in spite of standard surgical treatment there is recurrence of cyst. Eight percent of thyroglossal duct cyst may reoccur after adequate surgical excision. Objectives: To identify the recurrence of thyroglossal duct cyst after standard sistrunk’s operation. Methodology: A retrospective chart review performed in all the patients who were diagnosed with thyroglossal duct cyst and were managed by Sistrunk operation in B.P Koirala Institute of Health sciences, department of ORL and Head and Neck surgery from 2013 January1to 2015 December 31.The study was conducted on 37 patients’ age ranging from 4years to 68years. All the patients who had undergone Sistrunk’s operation and histopathologically diagnosed with thyroglossal duct cyst were analysed through hospital records. All records were reviewed for age, sex, location of cyst in neck and with relation to hyoid bone, postoperative complication and recurrence. Results: There was male predominance 67.56% and female only 32.43%.The most of the patients were between 1-15 yrs age group (48.64%). Thirty two patients presented with infrahyoid thyroglossal cyst and five patients with suprahyoid thyroglossal cyst. The post operative complications were in the form of wound dehiscence, haematoma, seroma, infection and there were two cases with recurrence out of thirty seven patients after Sistrunk operation in the form of persistence discharging sinus. Conclusion: A Sistrunk’s operation is effective in treating primary thyroglossal duct cyst with a comparably low recurrence rate. The intraoperative rupture of cyst is the most important risk factors predicting postoperative recurrence of thyroglossal duct cyst. Meticulous dissection of the thyroglossal duct cyst is very essential for the better surgical outcome.

Clinical experience of thyroglossal cyst management

<p class="abstract"><strong>Background:</strong> Thyroglossal cyst is a cystic swelling arising from embryological remnant of thyroglossal cyst. Cyst is typically located in the midline of the anterior neck and moves upward with tongue protrusion. The gold standard management for thyroglossal cyst is the Sistrunk procedure.</p><p class="abstract"><strong>Methods:</strong> Total of 32 patients of all ages and both sexes operated at Sapthagiri Institute of Medical Science and Research Centre, Bangalore during the study duration were included a detailed history and thorough physical examination was done to arrive clinical diagnosis. Ultrasound studies and FNAC were done in all cases to confirm the clinical diagnosis of thyroglossal cyst. Management was mainly surgical and Sistrunk operation was done in all cases. </p><p class="abstract"><strong>Results:</strong> Thirty two patients of with the diagnosis of thyroglossal cyst were managed from 2011 to 2018 in the department of ENT, Sapthagiri Institute of Medical Science, Bangalore, 20 (62.5%) were females and 12 (37.5%) were males age ranged from 5 to 40 years; mean age was 16.5 years.</p><p class="abstract"><strong>Conclusions:</strong> Thyroglossal cyst presents most commonly in paediatric age as cystic painless midline neck swelling. Diagnosis is made on clinical examination complimented with ultrasound and FNAC. Sistrunk operation is the treatment of choice to prevent recurrence and histopathological examination of the surgical specimen is must to rule out malignant transformation in the cyst.</p>

Presentation of Thyroglossal Cyst in Children

Background: Thyroglossal duct cyst a developmental anomaly present as a congenital cervical masses of neck in children.Objectives: To observe its deferent presentation and evaluate among the children.Materials and methods: This observational cross section study conducted among patients of eighteen years of age present with thyroglossal duct cyst between 2007 to 2012 in the department of ENT and Head- Neck surgery, Dhaka Medical College Hospital, Dhaka. All patients were operated by Sistrunk operation under (excision of total cyst and removal median portion hyoid bone) under general anesthesia. All specimens were histo-pathologically confirmed.Results: Among 24 children with thyroglossal cyst, 15 boys and 9 girls with male female ratio 1.67:1, age ranged from 4 years to 18 years (mean 9.46 std ±4.27). Male (mean 7.53±4.01years) child are younger than female (mean 12.67±2.39 years) child. 66.67% male children were below 10 years of age and 88.89% female children were over 10 years of age. According to the presentation site 17(70.83%) cases were juxtra hyoid, 4(16.67%) were suprahyoid and 3 (12.50%) were infrahyoid. 23 (95.83%) were present as midline swelling, only 1(4.17%) was present as left lateral infrahyoid swelling. 4(16.67%) patient were attended as thyroglossal fistulae with history of intervention. 4(16.67%) patient were developed recurrence followed by surgical resection within two years.Conclusion: Thyroglossal duct cyst present as an asymptomatic midline neck mass around the hyoid region in children. Complete resection along with median portion hyoid bone prevents recurrence.J. Paediatr. Surg. Bangladesh 5(2): 45-53, 2014 (July)

Modified Sistrunk Procedure: A Novel Method of Hyoid Resection using Skin Punches in Subhyoid Thyroglossal Cysts

ABSTRACT Background/objectives Managing thyroglossal duct cyst requires surgical excision of the cyst with its tract through the tongue base. Incomplete removal results in cyst recurrence, the common complications of incompletely performed Sistrunk procedure. The Modified Sistrunk procedure using skin punches increases the easiness of surgery and chances of complete removal of the tract. Materials and methods Resection of the middle body of the hyoid was done by coring out the nonossified bone with 4.5 mm skin punches under 3.5× loupes and the tract above till the base. Results A total of 14 primary cases were operated by this slight modification, and no recurrences were seen on 1 year of follow-up. Conclusion Sistrunk operation is the treatment of choice for primary thyroglossal cysts. Modified Sistrunk operation using skin punches results in easy and precise coring of the hyoid bone with the tract attached to it. Secondary cysts should be treated with removal of core of tongue base muscle and foramen cecum mucosa along with hyoid and scarred cyst excision. How to cite this article Naik SM, Kumar BLY, Ravishankara S, Shashikumar T, Deekshith RM. Modified Sistrunk Procedure: A Novel Method of Hyoid Resection using Skin Punches in Subhyoid Thyroglossal Cysts. Int J Otorhinolaryngol Clin 2016;8(3):97-100.

An Incidental Primary Papillary Carcinoma Arising in a Thyroglossal Duct Cyst: Report of a Rare Finding

ABSTRACTThe thyroglossal duct cysts (TGDCs) are the most common congenital anomaly of the thyroid, usually manifested as painless midline neck mass. Malignancy is very rare and is reported in around 1% of cases as an incidental finding after histopathological evaluation of resected cyst. Papillary carcinoma is the most common carcinoma reported in TGDC. Here, we report a case of 17-year-old-female, who presented with a gradually increasing midline neck mass which moves with swallowing. On imaging a diagnosis of infected TGDC was made. The Sistrunk operation was done and a diagnosis of primary papillary carcinoma arising in a TGDC was rendered histopathologically. The contemporary appearance of papillary carcinoma thyroid was reported in about 20% cases of TGDC carcinoma, thus it is essential to differentiate primary papillary carcinoma arising in a TGDC from those of metastatic papillary carcinoma thyroid by strict diagnostic criteria.