甲状舌管囊肿及瘘36例治疗效果分析

目的探讨甲状舌管囊肿及瘘管术后复发的原因及预防措施.方法对36例甲状舌管囊肿及瘘病例行Sistrunk术式,术前注入美蓝液于囊管内,以便术中分离追踪蓝染管支,切除足够舌骨中段,近舌盲孔处行荷包缝合术或电凝、微波等处理.结果36例中34例治愈,随访1年以上未见复发,2例复发,经再次手术治愈,复发率5.6%.结论对甲状舌管囊肿及瘘患者,术前、术中、术后处理好每个环节,是防止复发的关键.     

甲状舌管囊肿和瘘管术后复发的手术治疗

目的 探讨甲状舌管囊肿和瘘管术后复发再次手术的策略.方法 对2000-2006年收治的16例甲状舌管囊肿和瘘管术后复发患者进行回顾性分析.男10例,女6例.复发时间为术后6个月至4年,复发时年龄为12～35岁.对术中发现前次手术未切除舌骨中段者(10例),行常规Sistrunk术式手术切除;对前次手术切除舌骨中段者(6例),行扩大切除反复感染致与周围粘连组织,即扩大Sistrunk术式.结果 16例复发患者再次手术后,疗效满意.术后并发咽瘘和颈前血肿各1例,治疗后痊愈.随诊1～6年未见囊肿或瘘管复发.结论 合理应用常规Sistrunk术式与扩大Sistrunk术式是治疗甲状舌管囊肿复发病例的理想方法.     

颈部囊肿与瘘管的诊断和治疗

目的总结颈部囊肿与瘘管的诊治经验.方法93例行手术治疗,其中鳃裂囊肿15例,鳃裂瘘管10例,皮样囊肿1例,囊状淋巴管瘤4例,甲状舌骨囊肿37例,甲状舌管瘘管25例,癌性淋巴液囊肿1例,随访1～10年.结果93例中,囊性淋巴管瘤1例复发后失访,另1例行2次手术,癌性淋巴液囊肿1例半年后死于肺转移,鳃裂瘘管2例3次手术,甲状舌管瘘管1例复发,鳃裂瘘管术后1例迟发性面瘫,一次手术治愈,无术后并发症.结论颈部囊肿与瘘管的诊断除依据术前检查外,主要是依据术中的发现和术后病理检查.B超、CT等是有效的辅助检查手段.治疗上应彻底切除囊壁与瘘管,避免复发.术中应避免损伤颈部的大血管和神经.甲状舌管瘘管须切除舌骨中段2cm,这是防止术后复发的关键.     

扩大舌骨及周围组织切除治疗复发性感染性甲状舌管囊肿及瘘管

甲状舌管囊肿及瘘管是颈部常见的先天性畸形,手术切除是其惟一的治疗方法.由于甲状舌管的范围不确定,早期简单囊肿切除术式常有残留,导致复发.我们在Sistrunk术式的摹础上,扩大舌骨及其周围组织的切除范围,治疗38例复发感染性甲状舌管囊肿及瘘管,现报告如下.     

甲状舌管囊肿术后复发的原因和处理

目的探讨甲状舌管囊肿术后复发的原因和预防、处理措施。方法回顾性分析10例甲状舌管囊肿术后复发患者的资料。10例复发甲状舌管囊肿行Sistrunk术式再次手术切除。结果误诊和不当的手术方法是复发的主要原因。10例患者再次手术后,随访1年以上,疗效满意,未见有复发病例。结论正确的术前诊断,规范的Sistrunk术式和良好的手术技巧才能保障彻底地切除甲状舌管囊肿。     

甲状舌管残留临床分析

目的　探讨甲状舌管囊肿及瘘的复发因素及治疗情况。方法　回顾性分析我科2010年1月～2013年3月收治的114例甲状舌管囊肿及瘘患者的临床资料。结果　所有病例均经手术治疗,其中113例行Sistrunk术式切除,1例单纯囊肿切除,术后均一期愈合,随访6～46个月,3例复发,其中2例成人再次行Sistrunk扩大根治术,术后未再复发。结论　误诊、非典型的甲状舌管残留、急性感染时行手术、病变组织切除不完全、手术年龄过小和术中囊肿破裂是导致术后复发的重要因素,术前抗感染及术中对舌骨及残端的处理是治疗与防止复发的关键。     

小切口内镜辅助下甲状舌管囊肿切除术

目的　探讨小切口内镜辅助下甲状舌管囊肿切除保留舌骨的可行性及美容效果。方法　对8例甲状舌管囊肿患者，采用小切口内镜辅助下甲状舌管囊肿切除术。 结果　在保留舌骨的情况下，全部患者的甲状舌管囊肿被完整切除。术后切口一期愈合，无手术并发症；随访3个月～2年均无1例复发，美容效果满意。结论　在充分了解甲状舌管囊肿的解剖学特点，详细的术前检查，正确的术前诊断，选择合适的手术病例和良好的手术技巧下，小切口内镜辅助下甲状舌管囊肿切除术中保留舌骨彻底切除甲状舌管囊肿是可行的， 可获得较理想的美容及功能保全效果。     

111例甲状舌管囊肿及瘘管临床分析

目的　探讨甲状舌管囊肿及瘘管的临床诊治方法。方法　回顾性分析甲状舌管囊肿及瘘管患者111例的临床资料,对其临床特点、诊疗方法、术后并发症进行总结分析。结果　术后复发5例,其中4例有反复囊肿感染病史,术后呼吸困难2例,其中1例患者因长时间缺氧出现缺血缺氧性脑病,术后咽瘘1例。结论　手术方式和感染史是甲状舌管囊肿及瘘管术后并发症和复发的重要影响因素,病灶反复感染以及术后复发者易切除过多周围组织,术中应仔细结扎舌骨离断处减少咽瘘发生。颈部手术术后24 h应密切关注患者呼吸情况,切除范围大手术时间延长者术后可延迟拔管、予以激素治疗防止会厌前间隙水肿导致呼吸困难。     

颈外径路Sistrunk手术治疗成人复发性舌甲状舌管囊肿的临床分析

目的 探讨成人复发性舌甲状舌管囊肿（LTGDC）的临床特点、误诊原因及手术治疗。方法 回顾性分析2018年1月—2021年3月收治的6例反复复发的成年LTGDC患者,术前行甲状腺B超提示甲状腺位置并排除异位甲状腺,颈部CT检查明确肿物大小、部位及与舌骨的关系,喉咽部MRI明确肿物性质。手术均采用颈外径路Sistrunk手术。结果 6例患者曾误诊为会厌囊肿4例,舌根囊肿2例,均已行囊肿切除术,复发时间3周至1年。所有患者行颈外径路Sistrunk手术完整切除甲状舌管囊肿及瘘管,术后病理确诊为甲状舌管囊肿。术后随访1年以上无复发。结论 复发性舌根部或会厌间隙的囊性肿物应考虑LTGDC的可能性。所有患者术前均应行喉镜检查和颈部影像学检查以了解囊肿的形态、位置及其和舌骨的关系来选择手术方式。对于成人复发性LTGDC,Sistrunk手术可彻底切除囊肿减少复发。     

甲状舌管囊肿(瘘管)术后复发原因分析

甲状舌管囊肿和瘘管是常见疾病，如果处理不当容易导致术后复发.选择我院1991～2002年86例甲状舌管囊肿和31例甲状舌管瘘管术后复发的共23例病人进行总结，现将其临床资料分析报道如下。     

Thyroglossal duct cyst excision with hyoid bone preservation

The objective of this study is to assess complete removal of the thyroglossal duct cyst (TGDC) and its tract(s) to the base of the tongue with sparing of the hyoid bone. This is a prospective cohort study. Tertiary hospital (Zagazig university hospital). This prospective study was carried out on 21 patients who had been diagnosed preoperatively as TGDC or fistula. All patients were managed by dissection and removal of the TGDC and its tract(s) to the base of the tongue with sparing of the hyoid bone. The study was conducted on 12 males (57.14 %) and 9 females (42.85 %) with mean age 6.8 years (4–20 years). After histopathological examination; 16 patients (9 male and 7 female) were proved to have TGDC and 5 patients (3 male and 2 female) were proved to have dermoid cyst. The hyoid bone could be preserved in all cases except in two cases for whom the middle third of the hyoid bone was removed with the specimen. Multiple tracts were found in three cases and could be identified and dissected successfully with sparing of the hyoid bone. Identification, dissection, and complete excision of the TGDC with its attaching tract(s) could be performed without hyoid bone resection with no recurrence and minimal minor complication. The impacts of this hyoid bone preservation versus removal on the pattern of swallowing and retroglossal space need to be studied.     

Sistrunk revisited: a 10-year review of revision thyroglossal duct surgery at Toronto's Hospital for Sick Children

The definitive surgical management of thyroglossal duct cysts (TGDC) was elucidated by Sistrunk in 1920. However, the procedure is often poorly performed. We reviewed the charts of 143 patients managed for TGDC at the Hospital for Sick Children. Toronto, between 1978-1988. These patients underwent 214 surgical procedures at HSC and elsewhere for cure. One hundred and five patients needed only one procedure. Thirty-eight patients had recurrent disease. These needed 109 procedures for cure. Inadequate surgery was the direct cause of recurrence. Areas of surgical failure included misdiagnosis, inadequate hyoid bone resection and persistent infra or suprahyoid tract remnants. Representative case samples are outlined with clinical, surgical and pathologic correlation. We recommend performing the complete, classic Sistrunk procedure for all cases of TGDC.     

Thyroglossal duct remnants

Thyroglossal duct remnants presenting as a lump in the neck are usually called thyroglossal cysts. Meticulous dissection of the cyst and duct, along with the body of the hyoid bone (Sistrunk's operation) is necessary to avoid recurrence. The authors have reviewed the histology of 61 consecutive specimens diagnosed preoperatively as thyroglossal cysts and have found that a true cyst exists in only 46 per cent of cases.     

Endolaryngeal extension of thyroglossal duct cyst

Thyroglossal duct cysts are the most common congenital neck masses that develop during childhood, The masses develop from remnants of thyroglossal ducts, and typically appear as midline neck masses. Endolaryngeal extension of thyroglossal duct cysts has been reported mostly as midline neck swelling. We observed a case of extension of the thyroglossal duct cyst to the supraglottic area without neck swelling. A 50-year-old man presented with a 1-month history of foreign-body sensation in the throat. Fiberscopic and radiologic findings were similar to those associated with a saccular cyst, but its proximity to the hyoid bone raised the possibility of thyroglossal duct cyst. Operation was performed via an external incision to completely remove the cyst. Postoperative fiberscopy revealed that the aryepiglottic fold swelling had disappeared. Diagnosis of thyroglossal duct cyst was confirmed on the basis of pathological findings. In cases in which it is difficult to remove the cyst from the hyoid membrane, the hyoid bone midline portion should be dissected. Thyroglossal duct cysts should be considered in cases with a submucosal tumor in the supraglottic region, and radiological examinations should be performed.     

Lingual thyroglossal duct cysts--a review

Objectives

Lingual thyroglossal duct cysts (TGDC) are rare and liable to be missed in a cursory clinical examination. This study aimed to report the details of lingual TGDC from the authors’ series and review existing literature on the entity.

Methods

A 12 year retrospective survey of all cases of thyroglossal duct anomalies managed at a tertiary teaching hospital was conducted to identify those with lingual TGDC. Their clinical presentation, investigations, diagnosis and management were analysed. Case series from anecdotal published English literature were critically reviewed with particular regard to diagnosis and management.

Results

Of 78 cases of thyroglossal duct anomalies, 3 were lingual TGDC. All were females. One neonate presented with feeding difficulty and was clinically misdiagnosed as a ranula. The two older children presented with a cyst at the foramen caecum. The varied imaging and diagnostic dilemma are presented. The older children had cysts abutting the hyoid and were managed with transoral excision and a Sistrunk procedure; the neonate was managed with transoral excision only. This report also reviews the sparse literature and discusses specific issues in their treatment. The differential diagnoses encompass a wide array of developmental and neoplastic entities. Specific anatomic imaging with USG/CT/MRI and functional evaluation with radionuclide thyroid scan are essential investigative modalities. Besides a classical Sistrunk procedure and simple transoral excision, newer less invasive treatment options including marsupialisation and alcohol ablation have been reported.

Conclusions

In conclusion, the diagnosis and management of lingual TGDC needs to be individualised depending on their presentation and anatomic location. The Sistrunk's procedure is ideal for those in close proximity to the hyoid; however complete cyst excision would suffice in the rest.     

Obstructive lingual tonsil hypertrophy in recurrent thyroglossal duct cyst

The association between recurrent thyroglossal duct cyst (TGDC) and obstructive lingual tonsil hypertrophy has not previously been discussed. We present the case of a 7-year-old child whose medical and surgical course was complicated by these synchronous factors. The aim of this report is to present the risk factors for recurrence of TGDC and the unique challenge that concurrent lingual tonsil hypertrophy and airway obstruction present to management of patients.     

Thyroglossal duct cyst: a comparison between children and adults

PURPOSE: The purpose of the study was to evaluate the differences in the clinical characteristics of thyroglossal duct cysts (TGDC) between children and adults and to find a method for optimizing management of TGDC. MATERIALS AND METHODS: This study consisted of a retrospective chart review of patients with a diagnosis of TGDC from 1997 to 2002. All records were reviewed for age and sex, season of first visit, diagnostic methods, sizes and locations of cysts, surgical management, and recurrences. Differences between children and adults were analyzed. RESULTS: A total of 84 patients (32 children, 52 adults) were recruited. There were no significant differences in sex in either group. Compared with children, more adult patients had left-sided and infrahyoid cyst locations. The cyst sizes were significantly larger in adults. In this review, 90.4% of adults and 75% of children underwent a Sistrunk operation, whereas the others underwent cyst excision. There was a total of 5 recurrences, 2 in children and 3 in adults. CONCLUSION: Although the recurrence rates between children and adults and between different surgical managements were not significantly different, a Sistrunk procedure is recommended as the main operation of choice, especially in adults in whom a more extended tract resection should be performed.     

Recurrent thyroglossal duct cysts: a 23-year experience and a new method for management

OBJECTIVES: We present an experience in the management of primary and recurrent thyroglossal duct cysts (TGDCs) and describe a novel method for recurrent TGDC removal. METHODS: We performed a retrospective review of TGDC surgery at Children's Hospital in Seattle from 1980 to 2003. The surgical techniques for primary and recurrent TGDCs and the factors associated with TGDC recurrence were evaluated and analyzed. RESULTS: During the study period, 231 patients underwent 296 TGDC surgeries. Thirty-four of the 231 patients (15%) underwent a total of 88 procedures for recurrent TGDCs. Successful procedures used for secondary TGDC management included central neck dissection with directed base of tongue (BOT) excision in 6 of 9 patients (67%), secondary Sistrunk operation with limited BOT resection in 12 of 27 patients (44%), revision Sistrunk operation with BOT dissection in 7 of 11 patients (64%), and suture-guided transhyoid pharyngotomy in 8 of 8 patients (100%). Ten of the 231 patients (4%) had initial TGDC incision and drainage and then underwent a total of 21 procedures, excluding the incision and drainage. The factors associated with TGDC recurrence were inaccurate initial diagnosis (17 of 34 or 50%), infection (5 of 34 or 15%), unusual TGDC presentation (5 of 34 or 15%), and lack of BOT musculature removal (7 of 34 or 20%). The level of surgeon training affected the surgical outcome. CONCLUSIONS: Successful TGDC treatment requires consideration of factors associated with recurrence. Recurrent TGDCs can be treated by several methods, including suture-guided transhyoid pharyngotomy.