|Year : 2017 | Volume
| Issue : 4 | Page : 108-111
Outcome of treatment in patients with thyroglossal duct cyst in Zaria: Our experience
Tunde T Sholadoye1, Dotiro Chitumu2, Iliyasu Y Shuaibu2, Oluseyi O Ogunsua1, Ibrahim B Mohammed2
1 Department of Surgery, Division of Paediatric Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
2 Division of Otorhinolaryngology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
|Date of Web Publication||11-Apr-2018|
Dr. Iliyasu Y Shuaibu
Department of Surgery, Division of Otorhinolaryngology, Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, P. O. Box 10452, Kaduna
Introduction: Thyroglossal duct cyst (TGDC) is the most common congenital midline neck mass that most commonly present as gradually enlarging painless mass that moves with swallowing and protrusion of tongue, usually noticed in the first decade or in young adult. The aim of this study is to review the treatment outcome of patients with TGDC who presented to Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Materials and Methods: The record of patients managed for TGDC at the Division of Paediatric Surgery and Otorhinolaryngology of Department of Surgery Ahmadu Bello University Teaching Hospital Zaria, Kaduna, Nigeria over a 10-year period between January 2007 and December 2016 was reviewed. The information obtained included demographic characteristic and complete clinical information. The data were analyzed using a Statistical Package for Social Sciences version 21.0 software.
Results: A total of 19 patients were managed for TGDC within the years under review. The age range of the patients was 2–12 years with mean age and standard deviation of 6.6 and 3.5 years, respectively. Eleven patients (57.9%) presented within 6 months to 3 years of the disease onset. The location of the TGDC in majority of our patients 15 (78.9%) was infrahyoid. Most of the patients 17 (89.5%) had uncomplicated TGDC. Fifteen (79%) of the patients had Sistrunk operation, and no case of recurrence was observed after 2 years.
Conclusion: The outcome of treatment of TGDC is good, when early diagnosis and complete surgical excision of the cyst is achieved. Complete excision of the cyst without the removal of the hyoid bone may be adequate for suprahyoid cyst.
Keywords: Outcome, sistrunk operation, thyroglossal duct cyst, treatment
|How to cite this article:|
Sholadoye TT, Chitumu D, Shuaibu IY, Ogunsua OO, Mohammed IB. Outcome of treatment in patients with thyroglossal duct cyst in Zaria: Our experience. Sub-Saharan Afr J Med 2017;4:108-11
|How to cite this URL:|
Sholadoye TT, Chitumu D, Shuaibu IY, Ogunsua OO, Mohammed IB. Outcome of treatment in patients with thyroglossal duct cyst in Zaria: Our experience. Sub-Saharan Afr J Med [serial online] 2017 [cited 2018 Aug 16];4:108-11. Available from: http://www.ssajm.org/text.asp?2017/4/4/108/229754
| Introduction|| |
Thyroglossal duct cyst (TGDC) is the most common congenital cyst in the neck. It is also the most common congenital midline neck mass. The incidence of TGDC is not clear, but has been suggested to be present in 7% of the population. Majority of the patients with TGDC are children, and both sexes are affected equally.
TGDC arises as a diverticulum from the persistent thyroid descent tract, which begins from the foramen cecum and extends to the level of the thyroid gland.
TGDC mostly presents as gradually enlarging painless midline neck mass that moves with swallowing and protrusion of tongue, usually in the first decade or in young adult. However, an infected TGDC may be associated with fever, draining sinus(es), pains, and dysphagia. When TGDC occurs later in life, increase chance of malignant transformation to papillary thyroid carcinoma has been reported.
TGDC is found in the midline between tongue base and mediastinum, but 75% are near the level of the hyoid bone to the midline or slightly off to the left. Unusual presentations are not uncommon with TGDC. It can form on both the sides of the hyoid bone appearing as dumbbell shape lesion, it can also rarely present as cystic lesion within the larynx.
Ultrasound imaging and radionuclide scanning with or without fine needle aspiration cytology are important investigation in establishing the presence of normal thyroid tissues before surgery. Although only 10% of ectopic thyroid is found in the neck, it may represent the only thyroid tissue in 75% of patients.
Sistrunk operation is the standard treatment of TGDC. It involves excision of the cyst along with a cuff of tissue including the center portion of the hyoid bone and a core of tongue muscle up to foramen cecum, which is often associated with excellent outcome. When Sistrunk operation is well performed, recurrence rates can be reduced to fewer than 5%.
Although patients with TGDC are being managed regularly in our hospitals, there is dearth of literature on the treatment outcome of the disease in Nigeria. It is, thus, imperative to conduct this study and present our findings. The aim of this study is to review the treatment outcome of patients, who presented to Ahmadu Bello University Teaching Hospital (ABUTH) with TGDC over a period of 10 years. ABUTH is a tertiary health care facility in North Western Nigeria and is a referral center to many primary, secondary, tertiary, and private health facilities in Northern Nigeria.
| Materials and methods|| |
This was a retrospective descriptive study of patients who were managed for TGDC at the Divisions of Paediatric surgery and Otorhinolaryngology of Department of Surgery Ahmadu Bello University Teaching Hospital Zaria, Kaduna, Nigeria. Ethical approval was obtained from the Ethics Review Committee of Ahmadu Bello University Teaching Hospital Zaria. The record of patients managed for TGDC over a 10-year period between January 2007 and December 2016 was reviewed. All the patients included had complete clinical evaluation and surgery. Data obtained included demographic characteristics such as age, sex, main presenting symptoms, duration of symptoms, presence or absence of infection and or sinus, location of the cyst, type of surgery, and duration of follow-up. Excluded from the study were patients whose case records were either not found or did not have complete information.
The data were entered into the spreadsheet and analyzed using the Statistical Package for Social Sciences version 21.0 software (SPSS Inc., Chicago, Illinois, USA). Quantitative data were summarized as frequencies and percentages and presented as tables. Fisher exact test was used to determine P value and to test statistical significance, which was set at a P < 0.05.
| Results|| |
A total of 19 patients presented with TGDC within the years under review and there were 11 (57.9%) males and 8 (42.1%) females with sex ratio of 1.4:1. The age range of the patients was 2–12 years with mean age of 6.6 years (standard deviation = 3.5). Majority of the patients 14 (73.7%) are <10 years of age at presentation [Table 1].
Majority of the patients 11 (57.9%) presented within 6 months to 3 years of the onset of the symptoms of the disease followed by 7 (36.9%) within 4–9 years. Only one (5.3%) presented after 10 years of onset of the disease [Table 2].
The location of the TGDC in majority of our patients 15 (78.9%) was infrahyoid. Only 4 (21.1%) had suprahyoid TGDC [Table 3].
Seventeen patients (89.5%) presented with uncomplicated TGDC and one of them was a patient with sickle cell anemia. One patient (5.3%) presented with infected TGDC with the remaining one having thyroglossal duct fistula [Table 4].
The patient, who had infected TGDC, had incision and drainage with antibiotic coverage followed by surgery after 3 months. Fifteen (79%) of the patients had Sistrunk operation, while the remaining 4 (20.1%) had excision of the TGDC. Surgical site infection was the only complication observed in one patient (5.3%) after surgery [[Table 5] and [Table 6]]. An analysis to determine if there is any relationship between diagnosis and occurrence of complication after surgery was not statistically significant (Fisher exact test = 1.000).
|Table 6: Cross-tabulation of diagnosis at presentation and complication after surgery (n = 19)|
Click here to view
Most of the patients 13 (68.4%) had 1–2 years follow-up period after surgery. The average duration of follow-up of all the patients was 2 years and no recurrence was observed in any of them [Table 7].
| Discussion|| |
The TGDC is a developmental abnormality that results from a failure in obliteration of the embryogenic duct produced during thyroid migration. It is the most common developmental cyst encountered in the anterior neck region.
In our study, 19 patients presented with TGDC within the years under review. There were 11 (57.9%) males and 8 (42.1%) females with a sex ratio of 1.4:1. Similar findings were reported by Brousseau et al., Kathuria, and Neamþu et al. that reported no sex difference in patients with TGDC.,,
Majority of our patients 14 (73.7%) are <10 years of age, which suggest that TGDC is more common in the first decade of life, which is in agreement with the meta-analysis by Allard.
Though TGDC has been reported widely to occur within the first decade of life, there is dearth of literature on duration of symptoms at diagnosis. Eleven patients (57.9%) presented within 6 months to 3 years of onset of symptoms. Some case reports recorded duration of symptoms of 6 months and 1 year., Ali and Ahmed reported a symptom duration of 3 months to 18 years while Târcoveanu et al. reported symptoms duration of 1 month to 35 years at the time of presentation. The disparity in duration of symptoms at presentation may be explained by the age range of 20 months to 53 years and 1 month to 35 years reported by Ali and Ahmed and Târcoveanu et al., respectively, as against ours that was 2–12 years. The duration of symptoms at diagnosis may be of importance, because any delay in making diagnosis may lead to the development of complications with resultant poor surgical outcome. However, our study found no statistically significant relationship between delay in diagnosis and development of complications after surgery (Fisher exact test = 1.000).
Neamþu reported that most cysts were infrahyoid 64.28% and suprahyoid 21.42%. The infrahyoid location was also seen most commonly in 15 (78.9%) of our patients with the suprahyoid location accounting for 21.1%. Allard also reported the infrahyoid location to be the most common site for TGDC.
Majority of the patients 17 (78.9%) had uncomplicated TGDC at presentation, and one of them was a patient with sickle cell anemia. One patient (5.3%) presented with infected TGDC with the remaining one having a thyroglossal duct fistula. Other studies have consistently shown uncomplicated TGDC to be most common diagnosis at presentation followed by thyroglossal duct fistula.,, In our patient with infected TGDC, incision and drainage were performed. Deaver et al. reported good result with antibiotic and aspiration of abscess. In adults, papillary carcinoma may arise from the TGDC, particularly after the third decade.,, Histopathological review of the cysts in our study showed TGDC with no malignancy.
Sistrunk operation has been established to be the best surgical option for TGDC with the least recurrence rate. A modification of Sistrunk operation with incision at the upper pole of the cyst with acceptable outcome was described by Kathuria. Fifteen (78.9%) of our patients with infrahyoid TGDC had Sistrunk operation, while 4 (21.1%) with suprahyoid TGDC had excision of the cyst along with a core of tongue muscle up to foramen cecum. OK-234 intralesional injection with acceptable outcome was reported by Nobuo et al.; however, patients treated were few. There was no case of recurrence with an average follow-up period of 2 years, though we had a single case of surgical site infection that was managed appropriately. These findings may point to the fact that simple excision may be adequate for suprahyoid TGDC, though the number of patients, who had simple cyst excision was small.
| Conclusion|| |
The outcome of treatment of TGDC is good, when early diagnosis and complete surgical excision of the cyst are achieved. Complete excision of the cyst without removal of the hyoid bone may be adequate for suprahyoid cyst.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Brousseau VJ, Solares CA, Xu M, Krakovitz Koltai PJ. Thyroglossal duct cysts: Presentation and management in children versus adults. Int J Pediatr Otorhinolaryngol 2003;67:1285-90.
Mondin V, Muzzi E, Silver CE, Fagan JJ, Devaney KO, Rinaldo A. Thyroglossal duct cyst: Personal experience and literature review. Auris Nasus Larynx 2008;35:11-25.
Wetmore RF, Potsic WP. Differential diagnosis of neck masses. In: Paul WF, Bruce HH, editors. Cummings Otolaryngology − Head and Neck Surgery. 5th ed. Philadelphia: Mosby Elsevier 2010. p. 1234-57.
Kathuria B. Thyroglossal duct cyst & Sistrunk, a case series: Personal experience and literature review. J Otolaryngol ENT Res 2015;3:00064.
Vinidh P, Hisham M. Neck masses. In: Hussain SM, editor. Logan Turner’s Diseases of the Nose, Throat and Ear, Head and Neck Surgery. 11th ed. CRC Press Tailor and Francis Group; 2016. p. 327-37.
Yellon RF, Goldberg H. Update on gastroesophageal reflux disease in pediatric airway disorders. Am J Med Suppl 2001;111:78S-84S.
Sistrunk WW. The surgical treatment of cysts of the thyroglossal tract. Ann Surg 1920;71:121-4.
Pincus RL. Congenital neck masses and cysts. In: Bailey BJ, editor. Head & Neck Surgery − Otolaryngology. 3rd ed. New York, USA: Lippincott Williams & Wilkins 2001. p. 933.
Neamþu D, Cotulbea S, Marin AH, Lupescu S, Balica N, Ruja A et al.
Thyroglossal duct cysts and fistulae. J Exp Med Surg Res 2010;17:210-4.
Allard RH. The thyroglossal cyst. Head Neck Surg 1982;5:143-6.
Kishore CP, Naveen KD, Sampath CP. Thyroglossal duct cyst: An unusual presentation. Ear Nose Throat J 2006;85:454-56.
Ehsan K, Hossein PA. Double thyroglossal duct cyst derived from a single tract: A rare presentation. Iran J Otorhinolaryngol 2010;22:103-6.
Ali IS, Ahmed YA. Management of thyroglossal duct cyst. Open Otorhinolaryngol J 2008;2:26-8.
Târcoveanu E, Niculescu D, Cotea E, Vasilescu A, Crumpei F, Ferariu D et al.
Thyroglossal duct cyst. J Chirurg Iaşi 2009;5:84-93.
Arunkumar JS, Shibani A, Santhosh SG, Muhammed A. Management of thyroglossal duct remnants: Our experience. JKIMSU 2014;3:84-9.
Deaver MJ, Silman EF, Lotfipour S. Infected thyroglossal duct cyst. West J Emerg Med 2009;10:205-9.
Gordini L, Podda F, Medas F, Lai ML, Longheu A, Pisano G et al.
Tall cell carcinoma arising in a thyroglossal duct cyst: A case report. Ann Med Surg (Lond) 2015;4:129-32.
Dilip D, Rakesh R, Vijay N, Ravi M. A case of malignancy in a thyroglossal duct cyst − Recommendations for management. J Natl Med Assoc 2012;104:211-4.
Nadimi-Tehrani A, Karimi-Yazdi AR, Kazemi M. Primary papillary carcinoma in thyroglossal duct cyst. Acta Med Iran 2007;45:236-8.
Nobuo O, Shigeru F, Tomoo W, Tsukasa I. Treatment of thyroglossal duct cysts by OK-432. Laryngoscope 2012; 122: 131–3.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]