A Preliminary Study On The Improvement Of Diagnosis And Treatment Of Thyroglossal Duct Cyst In Children

The first part:Analysis of neck diseases misdiagnosed as thyroglossal duct cyst in 47 casesOBJECTIVE: most cases of thyroglossal duct cyst in children are diagnosed because of the presence of anterior cervical mass.The primary diagnosis is very easy to diagnose other neck diseases with anterior cervical mass as the main clinical manifestation.The purpose of this study is to analyze the cases of thyroglossal duct cyst in our hospital,explore the clinical characteristics and diagnosis of cervical diseases in children,and increase the accuracy of the preliminary diagnosis.METHODS: the clinical data of patients with thyroglossal duct cyst initially diagnosed in our hospital from January 2013 to June 2019 were analyzed retrospectively.Collect clinical data,including complaints,clinical manifestations,laboratory and imaging examinations,intraoperative anatomical features,postoperative pathology,etc.in January 2020,conduct a telephone follow-up of all children.The follow-up content includes whether there are complications in January,March and June after the operation,and whether there is abnormal in outpatient reexamination.To summarize and analyze the clinical epidemiological characteristics,diagnosis and preliminary diagnosis of cervical diseases in children.RESULTS: from January 2013 to June 2019,47 patients were initially diagnosed as thyroglossal cyst.47 patients were all treated for finding anterior cervical mass,including 3 outpatients and 44 inpatients.Among 44 hospitalized children,37 cases were confirmed by postoperative pathology,2 cases by intraoperative rapid pathology,3 cases by intraoperative anatomy,1 case by preoperative manicure + CT + nuclear medicine and 1 case by secondary B-ultrasound + CT.Three outpatients were diagnosed according to imaging examination.There were no complications in 1 month,3 months and 6 months postoperatively,and the reexamination results were normal.CONCLUSION: the primary diagnosis of midline cervical mass in children is easy to be diagnosed as dermoid cyst,ectopic thyroid,lymphadenitis,hemangioma,sublingual gland cyst,lymphangioma and other diseases.CT value and characteristic physical examination can be used for diagnosis and differentiation.The second part:Excision of Thyroglossal Cyst in Children by Transverse submentum Incision.BACKGROUND:Thyroglossal duct cyst is one of the most common neck diseases in children.The traditional thyroglossal duct cyst is excised on the surface of the tumor to get transverse incision along the skin striae.In order to reduce the influence of surgical scar on the appearance of neck after incision healing,the author's group moved the traditional incision position up to submentum.Retrospective analysis of transverse submentum incision for thyroglossal duct cyst in children,to explore the application of transverse submentum incision in thyroglossal duct cyst surgery.METHODS:submentum transverse incision for thyroglossal duct cyst removal in 14 children with thyroglossal duct cyst from January 2014 to December 2017.All cases were performed submentum dermatoglyphic incision,skin incision,subcutaneous tissue,platysma muscle incision,down lifting flap,along the white line incision and separation of banded muscle on both sides,see the mass along the wall of the capsule separated to the attachment of the hyoid bone,ablation of the mucosa of the capsule wall of the hyoid bone attachment,electrotome to break the hyoid bone.The cavity is indeed stopped after bleeding,and the skin is sutured continuously for continuous intradermal suture.The operation time,bleeding volume,severe complications,wound healing time and severe surgical scars were recorded.Close follow-up was performed to observe whether there was infection or recurrence of incisional wound.Parents were informed by telephone to go back to the outpatient clinic.RUTTER Children's Behavior Questionnaire was used to assess the children's psychological status.Vancouver Scar Rating Scale was used to evaluate the children's surgical scars,and To investigate whether parents satisfactory surgical methods.RESULTS:14 cases of thyroglossal duct cyst underwent transverse incision thyroglossal duct cyst excision successfully.The average operative time was 55 minutes,and the standard deviation was 10.5min,bleeding was less than 10 ml,postoperative hoarseness and weakness of voice,silence became low,wound healing time averaged one week,no serious surgical scars,no wound infection and recurrence.Among the normal children of the same age group,14 parents were satisfied with the operation.CONCLUSIONS:Excision of thyroglossal duct cyst under transverse incision is safe,reliable and satisfactory in appearance.The third part:A comparative study of thyroglossal duct cyst resection in children by submental transverse incision and hyoid horizontal incisionOBJECTIVE: there are many surgical approaches for thyroglossal cyst resection.The purpose of this study was to compare the differences in operative time,intraoperative bleeding volume,serious complications,wound healing time and surgical scars between two different surgical approaches(submental transverse incision and anterior hyoid horizontal incision).MATERIALS AND METHODS: from January 2014 to December 2017,the thyroglossal duct cyst of children in the same diagnosis and treatment group was analyzed retrospectively.All the patients underwent the Sistrunk operation.Among them,14 children chose the submental transverse incision as the operative approach,26 children chose the anterior hyoid horizontal incision as the operative approach.The differences between the two operation methods in operation time,intraoperative hemorrhage,serious complications,wound healing time and severe surgical scars were analyzed.RESULTS: 40 cases of thyroglossal duct cyst were studied in this study,aged 1-3 years.All the patients were operated successfully without changing the operation mode and increasing the second incision.There was no significant difference in operation time,intraoperative hemorrhage,wound healing time,postoperative complications,postoperative infection rate,recurrence rate within one year,and Vancouver Scar rating scale in January.CONCLUSION: it is a safe and feasible method to resect the thyroglossal duct cyst through the transverse incision in submaxillary region,and the postoperative effect is not different from that of the thyroglossal duct cyst at the level of anterior hyoid bone.