Excision of Thyroglossal Duct Cyst (Sistrunk Procedure)

This video demonstrates an excision of a thyroglossal duct cyst with special focus on 1) using the thyrohyoid membrane as a landmark and 2) dissection of the posterior hyoid space, which is the space between the thyrohyoid membrane and the posterior surface of the hyoid bone.

Contributors: John Maddalozzo MD, FAAP, FACS; Monica Herron, MPAS, PA-C; Sarah Maurrasse, MD; Jesse Arseneau (editor)

Ann & Robert H. Lurie Children’s Hospital of Chicago

Sistrunk Procedure for excision of thyroglossal duct cyst
Indications for Sistrunk procedure include: 1. Chronically infected cyst with fistula to the skin 2. Recurrent infections 3. Enlargement causing cosmetic concerns Surgery is indicated before cysts become infected, as there is a higher rate of recurrence after excision of previously infected cysts
Active infection
Supine position 1% lidocaine with 1:100,000 epinephrine. #15 blade 2-0 silk sutures 3-0 Prolene Irrigation Bipolar and standard cautery Quarter inch Penrose drain 3-0 nylon suture tied over baton. 4-0 Vicryl 5-0 Monocryl suture Dermabond Fluffs Surgifix dressing
An ultrasound confirms diagnosis and should include evaluation of the thyroid gland and evidence of any ectopic thyroid tissue. Thyroid replacement therapy may be indicated if the thyroglossal duct cyst contains the child’s only thyroid tissue. An MRI or CT can be ordered if ultrasound is insufficient to confirm diagnosis
Cricoid cartilage Hyoid bone Strap muscles Thyroid cartilage and notch Thyrohyoid membrane: The thyrohyoid membrane is used as conduit to identify the posterior aspect of the hyoid bone Posterior hyoid space (PHS)
Bleeding Infection Recurrence Scarring Dysphagia Injury to nearby neurovascular structures such as the hypoglossal nerve
Thank you to Vidal Maurrasse for providing voiceover
Oomen, K et al. Thyroglossal Duct Cyst and Ectopic Thyroid. Otolaryngol Clin N Am 48 (2015) 15-27. Chandra RK, Maddalozzo J, Kavark P. Histolgical characterization of the thyroglossal duct tract: implications for surgical management. Laryngoscope 2001: 111:1002-5 Maddalozzo J, Venkatesan TK, Gupta P. Complications associated with the Sistrunk procedure. Laryngoscope 2001; 111:119-23 Perkins JA, Inglis AF, Sie KC, et al. Recurrent thyroglossal duct cysts: a 23-year experience and a new method for management. Ann Otol Rhinol Laryngol 2006;115:850-6.

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