From the Guidelines
The treatment of choice for a thyroglossal duct cyst is the Sistrunk procedure, which involves complete surgical excision of the cyst, the central portion of the hyoid bone, and the tract leading to the base of the tongue, as it reduces recurrence rates to less than 10%. This approach is crucial in minimizing the risk of recurrence and potential complications, such as infection, which can be managed with antibiotics like amoxicillin-clavulanate 875/125 mg twice daily for 7-10 days in adults 1.
When evaluating a cystic neck mass, it is essential to consider the possibility of malignancy, especially in patients over 40 years old, where the incidence of cancer in a cystic neck mass increases to 80% 1. Imaging characteristics suggestive of malignant processes, such as large size, central necrosis, and extracapsular spread, should be assessed when a cystic neck mass is observed. Fine-needle aspiration (FNA) is recommended as the first-line modality for histologic assessment, but its sensitivity is lower in cystic cervical metastases (73%) compared to solid masses (90%) 1.
Key considerations in the management of thyroglossal duct cysts include:
- Complete surgical excision through the Sistrunk procedure to minimize recurrence rates
- Preoperative imaging studies, such as ultrasound, CT, or MRI, to confirm the diagnosis and rule out ectopic thyroid tissue
- Antibiotic treatment for infected cysts before surgical intervention
- Histologic assessment using FNA, with consideration for repeated or image-guided FNA if initial results are inadequate or benign
- Expedient open excisional biopsy if malignancy is suspected and FNA is inconclusive 1.
In terms of patient outcomes, the Sistrunk procedure has been shown to significantly reduce recurrence rates, resulting in improved morbidity, mortality, and quality of life for patients with thyroglossal duct cysts. Recovery after surgery typically takes 1-2 weeks, with minimal complications when performed by experienced surgeons.
From the Research
Definition and Presentation
- Thyroglossal duct cysts (TGDCs) are the most common congenital anomaly of the neck, typically presenting as a firm, midline mass 2.
- They occur as a result of the failure of the thyroglossal duct to obliterate during fetal development 3.
Treatment and Management
- The recommended treatment for TGDCs is the Sistrunk procedure, which involves the removal of the cyst, central portion of the hyoid bone, and a central core of deep tongue musculature 2, 4.
- This procedure has been shown to decrease the rate of recurrence from approximately 50% to 3-5% 2.
- In cases of malignant TGDCs, the Sistrunk procedure can still be effective, with a study showing no signs of tumor recurrence or complications after surgery 3.
- Alternative approaches, such as transoral endoscopic vestibular excision, have also been proposed for selected patients to avoid an external neck scar 5.
Risks and Complications
- Risk factors for recurrence after TGDC excision include surgery during the inflammatory phase, cyst rupture during dissection, multiple thyroglossal ducts, and technical error during the surgical procedure 4.
- A study analyzing the risks and complications of TGDC removal in adults found that the procedure is generally safe, with low complication rates, but that the risk of reoperation, surgical-site infections, and medical complications should be considered during preoperative planning 6.