[size=20px]A 10-year old girl has a recurrent thyroglossal duct cyst six months after excision. Which reoperative approach for recurrent thyroglossal duct cyst has the highest recurrence rate?

 

A repeat Sistrunk operation

 

B en bloc neck dissection

 

C suture guided transhyoid pharyngotomy

 

D Koempel suprahyoid frenulotomy technique[/size]

A

A

correct

 

Management of recurrent thyroglossal duct cyst (TGDC) remains a clinical challenge. A recent systematic review reports on 66 patients undergoing 114 operations for recurrent TGDC. The most common operations used were another Sistrunk procedure and an en bloc neck dissection. The en bloc dissection includes extended local excision of the central suprahyoid soft-tissue up to the base of the tongue, including musculature of the tongue base and extended local excision of infrahyoid soft tissue down to the level of the thyroid isthmus or pyramidal lobe.

 

Two additional operations were also evaluated: suture guided transhyoid pharyngotomy and Koempel suprahyoid technique. Suture guided transhyoid pharyngotomy is an approach that includes a transoral and transcervical approach. A suture is passed transorally through the foramen cecum into the cervical operative field allowing the suture to be pulled and delivering the base of the tongue into the cervical field promoting for aggressive soft tissue and even foramen cecum resection. The Koempel suprahyoid transfrenulum technique is completely oral, allowing easy access to the suprahyoid soft tissue and the foramen cecum. In this report, the latter two operations had 100% success without re-recurrence. En bloc dissection resulted in a 20% re-recurrence rate and a re-Sistrunk procedure had a 30% re-recurrence rate.