Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Elie Khalifee
Start Date
16-5-2025 11:30 AM
End Date
16-5-2025 1:30 PM
Presentation Type
Poster Presentation
Description
Background: Thyroglossal duct cyst (TGDC) is the most common congenital midline neck anomaly occurring in 7% of the population more commonly in infants or adolescents with no predilection to sex. [1] This anomaly consists of epithelial remnants due to failure of obliteration of the thyroglossal duct, a structure that forms as the thyroid gland originates at the foramen cecum of the tongue and is displaced caudally, anterior to or through the hyoid bone, towards its final position in the lower neck. Successful surgical management of TGDCs requires complete removal of the cyst and the duct. Initial surgery for these lesions consisted of simple local excision which had an unacceptably high recurrence rate of approximately 50%. In 1920, Sistrunk described his procedure that consists of the resection of the central portion of the hyoid bone along with a wide core of tissue between the hyoid bone and foramen caecum which greatly reduced the rate of recurrence to 10.8%. [2] The Sistrunk procedure remains the gold standard for the management of these cysts today. Despite having very low morbidity, the risk of recurrence has not been annulled with this procedure as well as other proposed variants of the Sistrunk. [3-6] Recurrent TGDC management remains a clinical challenge to most otolaryngologists. Different surgical approaches for the management of recurrent TGDCs have been reported in the literature with variable success rates and surgeon preference and comfort level continues to dictate the surgical technique used. [7] Dakin's solution (DS), dilute sodium hypochlorite solution, is a topical antiseptic agent that was first studied in the beginning of the 20th century and was widely used as a battlefield wound antiseptic during World War I. [8] Despite a decline in DS popularity with the advent of other wound treatment options such as vacuum assisted therapy, newer topical agents and discovery of antibiotics, [9] DS continues to play a role in wound care due to its low cost, wide availability and effectiveness. [10-14] DS utility has been reported in a variety of clinical settings including treatment of severe diabetic foot ulcer, wound care after orthopedic surgery, prevention of surgical wound infection in cases of complicated acute appendicitis, and drain care following mastectomy and/or lymph node dissection. [15, 18] DS utility in the management of recurrent TGDCs has not been reported yet.
Objectives/Goal: The aim of this study is to report our experience with DS packing as a novel surgical technique for the management of recurrent TGDCs.
Methods/Design: After obtaining institutional review board approval, a retrospective chart review of all patients younger than 18years of age who underwent a modified Sistrunk procedure at Children’s Mercy Hospital from January 2019 until December 2024 was performed. Inclusion criteria included pathology confirmation of TGDC after modified Sistrunk procedure. Demographic data was collected and included age at surgery, gender, and race. Clinical data included clinical presentation, presence of a cutaneous fistula, details of prior surgeries, trainee presence, cyst rupture during Sistrunk, procedures for management of recurrent TGDC, frequency and duration of DS packing changes, length of DS packing, use of pain medications, sedatives and anxiolytics during packing changes, complications other than recurrence, recurrence, and any subsequent interventions. Recurrence was defined as a recurring midline cyst or fistula requiring surgical intervention.
Results: A total of 143 patients were included in the study, with a mean age of 6.6 years (SD 4.2). Among these, 42% were female and 58% were male. The racial distribution was predominantly White (71%), followed by Other (17%), Black or African American (10%), and Asian (1.4%). Of the 143 patients, 9 experienced recurrence, giving a recurrence rate of 6.3%. There were no significant associations between recurrence and age (p = 0.77), gender (p = 0.30), or race (p = 0.68). However, patients with a history of neck sinus tract (mucoid drainage) had a significantly higher risk of recurrence (p = 0.027). A borderline association was also found between a history of incision and drainage prior to surgery and recurrence (p = 0.049). In the multivariate analysis (Table 2), no factors were found to be significant predictors of recurrence when controlling for other variables. Age (p = 0.9), gender (p = 0.3), and race (p = 0.4) were not significantly associated with recurrence. The previously significant univariate association between neck sinus tract (mucoid drainage) and recurrence (p = 0.027) was no longer significant in the multivariate model (p = 0.6), suggesting potential confounding effects. Similarly, the borderline significance of incision and drainage history (p = 0.049) did not hold in the multivariate analysis (p = 0.8). A total of 8 patients who experienced recurrence underwent Dakin’s solution (DS) packing for the management of recurrent TGDC. DS packing was highly effective, achieving a 100% success rate, with no further recurrences observed during the study period. Additionally, none of the patients were readmitted to the hospital within 3 months of discharge. The total duration of packing changes had a median of 12 days (IQR 9–15 days).
Conclusions: Several factors are associated with TGDC recurrence. In our study, previous incision and drainage and presence of a sinus tract appear to imply increased risk of recurrence. All of these recurrences were successfully treated with DS packing, without further recurrence. Herein, we present otolaryngologists with a novel surgical option to add to their arsenal for managing recurrent TGDCs. DS packing seems to be an effective and safe approach for treating this challenging condition.
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A Novel Surgical Technique for the Management of Recurrent Thyroglossal Duct Cysts Using Dakins Solution Packing
Background: Thyroglossal duct cyst (TGDC) is the most common congenital midline neck anomaly occurring in 7% of the population more commonly in infants or adolescents with no predilection to sex. [1] This anomaly consists of epithelial remnants due to failure of obliteration of the thyroglossal duct, a structure that forms as the thyroid gland originates at the foramen cecum of the tongue and is displaced caudally, anterior to or through the hyoid bone, towards its final position in the lower neck. Successful surgical management of TGDCs requires complete removal of the cyst and the duct. Initial surgery for these lesions consisted of simple local excision which had an unacceptably high recurrence rate of approximately 50%. In 1920, Sistrunk described his procedure that consists of the resection of the central portion of the hyoid bone along with a wide core of tissue between the hyoid bone and foramen caecum which greatly reduced the rate of recurrence to 10.8%. [2] The Sistrunk procedure remains the gold standard for the management of these cysts today. Despite having very low morbidity, the risk of recurrence has not been annulled with this procedure as well as other proposed variants of the Sistrunk. [3-6] Recurrent TGDC management remains a clinical challenge to most otolaryngologists. Different surgical approaches for the management of recurrent TGDCs have been reported in the literature with variable success rates and surgeon preference and comfort level continues to dictate the surgical technique used. [7] Dakin's solution (DS), dilute sodium hypochlorite solution, is a topical antiseptic agent that was first studied in the beginning of the 20th century and was widely used as a battlefield wound antiseptic during World War I. [8] Despite a decline in DS popularity with the advent of other wound treatment options such as vacuum assisted therapy, newer topical agents and discovery of antibiotics, [9] DS continues to play a role in wound care due to its low cost, wide availability and effectiveness. [10-14] DS utility has been reported in a variety of clinical settings including treatment of severe diabetic foot ulcer, wound care after orthopedic surgery, prevention of surgical wound infection in cases of complicated acute appendicitis, and drain care following mastectomy and/or lymph node dissection. [15, 18] DS utility in the management of recurrent TGDCs has not been reported yet.
Objectives/Goal: The aim of this study is to report our experience with DS packing as a novel surgical technique for the management of recurrent TGDCs.
Methods/Design: After obtaining institutional review board approval, a retrospective chart review of all patients younger than 18years of age who underwent a modified Sistrunk procedure at Children’s Mercy Hospital from January 2019 until December 2024 was performed. Inclusion criteria included pathology confirmation of TGDC after modified Sistrunk procedure. Demographic data was collected and included age at surgery, gender, and race. Clinical data included clinical presentation, presence of a cutaneous fistula, details of prior surgeries, trainee presence, cyst rupture during Sistrunk, procedures for management of recurrent TGDC, frequency and duration of DS packing changes, length of DS packing, use of pain medications, sedatives and anxiolytics during packing changes, complications other than recurrence, recurrence, and any subsequent interventions. Recurrence was defined as a recurring midline cyst or fistula requiring surgical intervention.
Results: A total of 143 patients were included in the study, with a mean age of 6.6 years (SD 4.2). Among these, 42% were female and 58% were male. The racial distribution was predominantly White (71%), followed by Other (17%), Black or African American (10%), and Asian (1.4%). Of the 143 patients, 9 experienced recurrence, giving a recurrence rate of 6.3%. There were no significant associations between recurrence and age (p = 0.77), gender (p = 0.30), or race (p = 0.68). However, patients with a history of neck sinus tract (mucoid drainage) had a significantly higher risk of recurrence (p = 0.027). A borderline association was also found between a history of incision and drainage prior to surgery and recurrence (p = 0.049). In the multivariate analysis (Table 2), no factors were found to be significant predictors of recurrence when controlling for other variables. Age (p = 0.9), gender (p = 0.3), and race (p = 0.4) were not significantly associated with recurrence. The previously significant univariate association between neck sinus tract (mucoid drainage) and recurrence (p = 0.027) was no longer significant in the multivariate model (p = 0.6), suggesting potential confounding effects. Similarly, the borderline significance of incision and drainage history (p = 0.049) did not hold in the multivariate analysis (p = 0.8). A total of 8 patients who experienced recurrence underwent Dakin’s solution (DS) packing for the management of recurrent TGDC. DS packing was highly effective, achieving a 100% success rate, with no further recurrences observed during the study period. Additionally, none of the patients were readmitted to the hospital within 3 months of discharge. The total duration of packing changes had a median of 12 days (IQR 9–15 days).
Conclusions: Several factors are associated with TGDC recurrence. In our study, previous incision and drainage and presence of a sinus tract appear to imply increased risk of recurrence. All of these recurrences were successfully treated with DS packing, without further recurrence. Herein, we present otolaryngologists with a novel surgical option to add to their arsenal for managing recurrent TGDCs. DS packing seems to be an effective and safe approach for treating this challenging condition.
