[size=20px]A four-year old child undergoes a Sistrunk procedure for resection of a thyroglossal duct cyst. Four months postoperatively a mass is again present in the upper midline of the neck.

 

Which of the following is the best predictor for recurrence of thyroglossal duct tissue following a Sistrunk procedure?

 

A use of a drain at the initial resection

 

B intraoperative rupture of cyst

 

C postoperative infection

 

D preoperative infection

 

E patient age[/size]

(Untitled)

 

b

B.

correct answer

D preoperative infection

 

The Sistrunk procedure, described in 1920, is the standard operation for removal of thyroglossal duct tissue. Recurrence rates of thyroglossal duct tissue after this procedure are between 10 and 15%. There are no prospective studies of risk factors for recurrent thyroglossal tissue after the Sistrunk procedure. However, multiple case reviews have indicated that recurrence rates are higher after the Sistrunk procedure if there has been infection of the tissue prior to or at the time of operation. This is the most frequently reported association with recurrence. It is theorized that previous infection or inflammation may make the margins of the thyroglossal duct tissue more difficult to define, thereby requiring a wider dissection and more aggressive dissection into the base of the tongue.

 

A retrospective study also reported that those patients with recurrent thyroglossal duct tissue had a greater number of thyroglossal duct tracts in the originally excised tissue but noted no increase in recurrence if the cyst was ruptured intraoperatively. Another study indicated that there was no difference in recurrence rates between pediatric surgeons and pediatric otolaryngologists even though the latter group commonly used drains. There was also no predictive value of patient age. A higher incidence of recurrent disease with postoperative infection has been reported but the patient series is small and it is debatable as to whether the postoperative infections were really just manifestations of recurrent disease. This relationship is not reported in other studies. There are no data to indicate that recurrent disease is greater if the thyroglossal cyst is off midline.