Airway injury complicating excision of thyroglossal duct cysts.
OBJECTIVE
We report on four cases of thyroglossal duct cyst (TGDC) excision using the Sistrunk procedure (resection of the mid-portion of the hyoid bone in continuity with a thyroglossal duct cyst tract) in which the airway was significantly injured. The patterns of injury, their treatment and outcomes as well as preventative measures are detailed.


METHODS
Retrospective analysis of four patients referred to a tertiary medical center after sustaining injury to the cricothyroid membrane and/or thyroid cartilages while undergoing a Sistrunk excision of a TGDC.


RESULTS
Three patients were repaired after a delay; one patient was immediately repaired. All four patients required application of cartilage grafts, and all ultimately required tracheotomy. Decannulation was achieved in the four patients after an average of 4.5 months, and none suffered from aspiration. Voice outcomes were poor in 3/4.


CONCLUSIONS
The Sistrunk procedure has been advocated for TGDC excision, citing a low recurrence rate. However, if the thyroid cartilage is mistaken for the hyoid bone, significant airway injury occurs. Urgent laryngotracheoplasty is indicated, but poor voice outcomes are anticipated.


CONCLUSIONS
Surgeons employing the Sistrunk procedure to excise TGDC must remain oriented to midline cervical anatomy, particularly as the hyoid my override the thyroid notch in young children, placing the larynx at risk for significant injury.
Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, MLC 2018 3333, Burnett Avenue, Cincinnati, OH 45229-3039, USA. ctwootten@gmail.com
C T
CT
Wootten
S L
SL
Goudy
M J
MJ
Rutter
J P
JP
Willging
R T
RT
Cotton
D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007821:Laryngeal Muscles / Q000293:injuries / Q000601:surgery; D007830:Larynx / Q000293:injuries* / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D013955:Thyroglossal Cyst / Q000601:surgery*; D013957:Thyroid Cartilage / Q000293:injuries / Q000601:surgery; D014140:Tracheotomy