The Analysis Of Pathology And The Possible Reason Of Drainage After Thyroglossal Cyst Excision

Background:Thyroglossal duct (TGD) remnants are a relatively frequent problem in both the pediatric and adult populations. The standard-of-care treatment typically involves an excision of a midline cervical mass, which includes the central portion of the hyoid, as described by Sistrunk in 1920. The upper limits of the dissection remain variable based on surgical preferences. Some groups suggest limiting the dissection to tissue immediately above the hyoid, while others suggest dissection as high as the mucosal surface of the tongue base. Regardless of technique used, the postoperative course can be complicated by mucopurulent drainage, either via the incision line or as a recurrent fluid collection. Most surgeons assume that this drainage is secondary to residual thyroglossal duct tissue within the neck. Once drainage has been identified, the patient often undergoes a "central neck dissection," which has wider limits of dissection than the standard Sistrunk excision. Clinical experience suggests that post-Sistrunk mucopurulent drainage can be difficult to stop, with patients needing to return to the operating room for repeated surgery to remove possible residual thyroglossal duct tissue. At times, residual TGD tissue is not found within the re-excision block, in spite of what would otherwise seem to be a thorough extirpation of the pathway of the thyroid primordia. Clearly, this experience can be frustrating for both patient and physician alike and can put critical structures at risk for iatrogenic damage. More information is needed about the source(s) of post-Sistrunk mucopurulent drainage and how best to control it safely.Objective:This study which aims at the pathology and drainage of the Thyroglossal duct excision, retrospectively analyzes 192 cases of thytroglossal cyst cured by excision in Sir Run Run Shaw Hospital the affiliated hospital of Zhejiang University from 1994 to 2009.Method:we retrospectively analyze 192 cases of the pathology and drainage after thytroglossal cyst excision in Sir Run Run Shaw Hospital the affiliated hospital of Zhejiang University from 1994 to 2009.Results:1.Clinical data:the sex ratio is 4:5, the age is from 1-79, male 85, female 107, the youngest patient is 1, the oldest is 79。All the patients are under Sistrunk operation and pathological examination。2. Pathological examination:185 thyroglossal cyst,4 Inflammatory granulation,1 midline cervical cyst of branchiegenic origin,1 Squamous cell papilloma,1 ectoptic thyroid gland.。3.5 patient have the second operation because of recidivation。4.8 patient have mucopurulent drainage after operation。Conclusion:the reason of the drainage of the patient who have the sistrunk operation may contain the injury of the salivary gland, and the pathological diagnosis may help us make the right decision to deal with the drainage.