The imperative of the Sistrunk operation: review of 160 thyroglossal tract remnant operations.
OBJECTIVE
Analysis of the pre- and postoperative features, long-term follow-up, and complications.


METHODS
Case series with chart review of 160 thyroglossal tract remnant excisions over a 20-year period (1988-2007).


RESULTS
The mean age of diagnosis was 10.9 +/- 14.2 years with 63.8 percent male predominance. There was a prior history of thyroglossal tract remnant infections in 70 percent of patients, and 30 percent presented with cutaneous fistulas. The majority had ultrasound imaging that identified cysts mainly (66.7%) in the infrahyoid region. Preoperative fine-needle aspirations in 18 patients were benign. On pathological reevaluation, 26.5 percent had thyroid tissue inside the remnant, with one case of papillary carcinoma. After the Sistrunk operation, postoperative complications occurred in 7.5 percent including a 1.9 percent recurrence rate.


CONCLUSIONS
All age groups had similar clinical presentations and outcomes. Ultrasound is a reliable and appropriate imaging modality for most patients. Surgery must effectively incorporate the tract and cyst to allow low recurrence rates (<2%). Clinically diagnosed thyroglossal tract remnant may, in fact, be other pathologies in 10 percent of cases. Nevertheless, our recommendation is a Sistrunk procedure for all midline neck lesions suspected to be a thyroglossal tract remnant.
Hirshoren
Nir
N
Department of Otolaryngology-Head and Neck Surgery, Hebrew University School of Medicine-Hadassah Medical Center, Jerusalem, Israel. drnir@hadassah.org.il.
Neuman
Tzahi
T
Udassin
Raphael
R
Elidan
Josef
J
Weinberger
Jeffrey M
JM
D000293:Adolescent; D044963:Biopsy, Fine-Needle; D002648:Child; D017577:Cutaneous Fistula / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D013955:Thyroglossal Cyst / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014463:Ultrasonography