If the recurrence of thyroglossal duct cysts (TGDC) occurs as a consequence of incomplete resection, will the application of the posterior hyoid space (PHS) to the Sistrunk procedure minimize the risk of recurrent TGDC?
Explore this issue:September 2010
Background: TGDCs are the most common congenital abnormality in the neck, with surgical extirpation recommended because of the likelihood of recurrent infections and rare cancer. While the Sistrunk procedure is the most efficacious method of surgical extrication, a modified approach used by the authors includes a previously undescribed anatomic area called the PHS.
Study design: A retrospective study
Setting: Department of Surgery, Division of Pediatric Otolaryngology, Children’s Memorial Hospital, Chicago, Ill.
Synopsis: Between April 2003 and August 2008, 60 surgical cases that included age, symptoms, imaging, thyroid status, pathology results and postoperative complications were selected for analysis. All patients underwent a modified Sistrunk procedure and had a postoperative diagnosis of TGDC. The modified approach included skeletonization of the thyroid cartilage to identify the alae and notch of the cartilage. The thyrohyoid membrane was then identified and used as a conduit to locate the posterior aspect of the hyoid bone and to evacuate the PHS anatomic area.
Average patient follow-up was 17 months, with one patient having a recurrence and four patients developing a minor complication. The authors said the anatomy of the PHS has historically been overlooked because when the larynx is harvested at autopsy, the hyoid and epiglottis are not usually included with the specimen.
Bottom line: The authors report a modification of the classic Sistrunk procedure and describe the anatomy of the PHS, along with a low recurrence rate utilizing the modified surgery.
Citation: Maddalozo J, Alderfer J, Modi V. Posterior hyoid space as related to excision of the thyroglossal duct cyst. Laryngoscope. 2010;120(9):1773-1778.
—Reviewed by Sue Pondrom