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Posterior hyoid space as related to excision of the thyroglossal duct cyst§

Authors

  • John Maddalozzo MD, FAAP, FACS,

    Associate Professor, Corresponding author
    1. Department of Surgery, Division of Pediatric Otolaryngology , Children's Memorial Hospital, Chicago, Illinois, U.S.A.
    2. Northwestern University Feinberg School of Medicine , Chicago, Illinois, U.S.A.
    • Children's Memorial Hospital, Division of Otolaryngology, 2300 Children's Plaza, Box #25, Chicago, IL 60614
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  • Jeremy Alderfer MD,

    1. Department of Surgery, Division of Pediatric Otolaryngology , Children's Memorial Hospital, Chicago, Illinois, U.S.A.
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  • Vikash Modi MD

    1. Department of Surgery, Division of Pediatric Otolaryngology , Children's Memorial Hospital, Chicago, Illinois, U.S.A.
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  • Thesis submittal 2009 was accepted by the American Laryngological, Rhinological and Otological Society, Inc., The Triological Society.

  • All financial support was from the our own entities within the Children's Memorial Hospital Research Fund that was available from the Division of Pediatric Otolaryngology Division, Department of CV Surgery. We assumed all costs.

  • §

    The authors have no financial intersts to disclose.

Abstract

Objectives/Hypothesis:

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.

Study Design:

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. Laryngoscope, 2010

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