M. S. Arda1, G. Ortega2, V. F. Pinard2, E. Jelin1, F. Qureshi1 1Children’s National Medical Center,General Pediatric Surgery,Washington, DC, USA 2Howard University College Of Medicine,Department Of Surgery,Washington, DC, USA
Introduction: Thyroglossal Duct Cyst (TGDC) is the most common congenital neck in children. Surgical management by sistrunk procedure is the mainstay of treatment. Pediatric general surgeons (GS) and otolaryngologists (ENT) perform this procedure. Recurrence occurs in 6-10% of children. Studies have suggested preoperative infection, age, abscess and multicystic histology as possible underlying reasons for recurrence. The impact of surgical subspecialty has not been studied as ENT surgeons often core out the foramen cecum at the base of the tongue. The aim of our study is to evaluate surgical outcomes of children undergoing sistrunk procedures for TGDC based on surgeon type at an academic pediatric institution.
Methods: A retrospective chart review of children diagnosed with TGDC from 2004-2014 was conducted. Inclusion criteria were children who underwent the sistrunk procedure and surgeon type was either GS or ENT. Basic demographic, preoperative clinical signs, age at surgery, surgeon type, operative characteristics, postoperative complication and recurrence rates were extracted. The primary outcome was recurrence rate of TGDC. Statistical analysis was conducted via descriptive statistics, t-test, and Pearson chi-square with p < 0.05 deemed statistically significant.
Results: A total of 165 patients met our inclusion criteria. 53.3% were male with swelling being the most frequent preoperative sign (92.7%), followed by infection (17.4%) and fistula (15.7%). The mean age at surgery was 5.4 years. The mean volume of TGDC excised was 4.7cm3 and most were single cyst (90.5%) The most common complications were swelling (82.0%), followed by seroma (9.0%) and wound infection (7.3%). ENT surgeons performed 106 procedures (64.2%), the mean age at surgery for GS and ENT were 5.6 and 5.3 years, respectively (p=0.67). The mean volume of TGDC for GPS and ENT were 2.5 and 5.9 cm3, (p<0.01). The overall recurrence rate was 8.4%. The complications by surgeon type were swelling (GPS 18.6%, ENT 17.9%, p=0.90), seroma (GPS 8.5%, ENT 9.4%, p=0.83), and wound infection (GPS 6.8%, ENT 8.5%, p=0.69). The recurrence rates were 11.7% and 6.6% for GPS and ENT, respectively (p=0.25).
Conclusion: Our study demonstrates that there is no difference in recurrence rates for TGDC excision between GS and ENT specialties. There was no added benefit of foramen cecum resection. Furthermore, no preoperative predictive factors for recurrence were identified. This study is limited by its retrospective nature and a larger prospective study may be able to identify differences between GS and ENT procedures.