Posterior hyoid space as related to excision of the thyroglossal duct cyst.
OBJECTIVE
The anatomy of the anterior neck in the area of the hyoid, thyrohyoid membrane, and epiglottis is herein redescribed and compared to its classical depiction. The concept of the posterior hyoid space (PHS) is defined and substantiated through review of archived tissue and cadaver larynx dissection as well as by observation at many surgical dissections. The true anatomy of these relationships provides an insight into the effectiveness of the Sistrunk procedure. The author believes that recurrence of thyroglossal duct cysts (TGDC) occurs as a consequence of incomplete resection of: 1) microscopic suprahyoid ductules and/or 2) infra- and perihyoid tissue.


METHODS
The senior author has been using the concept of the posterior hyoid space as applied to the Sistrunk procedure for more than 20 years. A retrospective study was done on cases from April 2003 to August 2008, and outcome was reviewed and compared to historical controls to determine the impact of applying this anatomic concept.


METHODS
A retrospective chart review was undertaken on 60 surgical cases performed for a 5-year period with clinical follow-up extended to an additional 7 months. Data collected included age at surgery, presenting symptoms, imaging characteristics, thyroid status, pathology results, and postoperative complications. All 60 were under the age of 18 who underwent a modified Sistrunk procedure and had a postoperative diagnosis of TGDC. Each patient had a minimum follow-up period of 4 months to check for recurrences. No revision was included in this study.


RESULTS
Sixty patients met criteria for the study. There was one recurrence (1.67%); a complication rate of 6.67%. Complications were minor and wound related. Mean follow-up was 17 months.


CONCLUSIONS
The technique of applying the concept of a PHS to ensure the complete resection of the middle third of the hyoid bone and offending tissues is believed to decrease recurrence of TGDC secondary to incomplete resection in the perihyoid area.
Maddalozzo
John
J
Department of Surgery, Division of Pediatric Otolaryngology, Children's Memorial Hospital, Chicago, Illinois 60614, USA. jpmaddalozzo@childrensmemorial.org
Alderfer
Jeremy
J
Modi
Vikash
V
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006928:Hyoid Bone / Q000473:pathology / Q000601:surgery*; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D055502:Secondary Prevention; D013955:Thyroglossal Cyst / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography