title: Recurrent thyroglossal duct cysts: a 23-year experience and a new method for management.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Pediatric Otolaryngology, Children's Hospital and Regional Medical Center, Seattle, WA 98105-0371 , USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Perkins
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Inglis
authors.forename: Kathleen C Y
authors.initials: KC
authors.lastname: Sie
authors.forename: Scott C
authors.initials: SC
authors.lastname: Manning
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D037981:Neck Dissection / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D012189:Retrospective Studies; D013955:Thyroglossal Cyst / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome