From the Research
A thyroglossal duct cyst is a congenital neck mass that requires proper management, and the recommended treatment for a 9-year-old child is surgical removal via the Sistrunk procedure, as it is the most effective way to prevent recurrence and minimize complications 1.
Definition and Symptoms
A thyroglossal duct cyst is a congenital neck mass that forms from remnants of the thyroglossal duct, which normally disappears during fetal development. It is not dangerous in most cases but requires proper management. These cysts typically appear as a painless, smooth midline neck swelling that moves upward when the tongue is protruded or during swallowing. Symptoms include:
- A visible lump in the front of the neck (usually below the hyoid bone)
- Occasional tenderness, redness or drainage if infected
- Rarely difficulty swallowing or breathing if the cyst becomes very large
Management
For a 9-year-old child with a thyroglossal duct cyst, the recommended management is surgical removal via the Sistrunk procedure, which involves removing the cyst, the central portion of the hyoid bone, and the tract leading to the base of the tongue. This extensive removal is necessary to prevent recurrence, which occurs in 5-10% of cases even with proper surgery 2. While waiting for surgery, any infection should be treated with antibiotics such as amoxicillin-clavulanate (20-40 mg/kg/day divided twice daily) or clindamycin if penicillin-allergic. Surgery is generally performed as an outpatient procedure with the child returning to normal activities within 1-2 weeks.
Recurrence and Complications
Recurrence of thyroglossal duct cysts after a Sistrunk procedure is an ongoing challenge that occurs in approximately 5% of cases 1. Postoperative infection and seroma do not cause recurrence but may be predictors of residual disease and warrant closer surveillance. The Sistrunk procedure has been shown to be safe and effective in treating thyroglossal duct cysts, with a low recurrence rate of 2.30% in some studies 2.
Key Points
- Thyroglossal duct cysts are congenital neck masses that require proper management
- The recommended treatment is surgical removal via the Sistrunk procedure
- Recurrence occurs in 5-10% of cases even with proper surgery
- Postoperative infection and seroma may be predictors of residual disease and warrant closer surveillance
- The Sistrunk procedure is safe and effective in treating thyroglossal duct cysts, with a low recurrence rate in some studies 2, 1