The Sistrunk procedure is the standard method for excision of a thyroglossal duct cyst. It involves removal of the entire pathway of the cyst, along with a cuff of surrounding tissue and a portion of the hyoid bone.
Indications for Surgery:
Thyroglossal duct cyst
Contraindications to Surgery:
- Medical comorbidities that would preclude surgical or anesthesia risk
- Surgery should be delayed until any infection has resolved with antibiotic therapy
- Management of median ectopic thyroid (i.e., where all functional thyroid tissue would be removed during the procedure) is controversial
- Thyroid ultrasound
- Thyroid scintigraphy if there is evidence of hypothyroidism or no thyroid is seen in the neck on ultrasound
- The patient is placed supine on the operating table and general anesthesia is induced via endotracheal intubation.
- The table is rotated 180 degrees and a shoulder roll is placed under the patient.
- The incision site is injected with 1% lidocaine with 1:100,000 epinephrine, and a transverse skin incision is made at the level of the cricothyroid membrane.
- Subplatysmal flaps are elevated and dissection performed to delineate the cyst boundaries before proceeding medially to the hyoid.
- The strap muscles are dissected from the central one-third of the hyoid and bone cutters are used to mobilize the central portion of the hyoid bone.
- Dissection is carried out superiorly to the base of tongue, close to the foramen cecum, from where the tract originates.
- The tract is clamped, cut, and suture ligated, allowing the thyroglossal duct cyst, middle one-third of the hyoid, and the tract to be removed en bloc.
- Valsalva is induced with the assistance of the anesthesiologist, and hemostasis is achieved using bipolar electrocautery.
- The wound is irrigated and a drain may be inserted.
- The strap muscles are reapproximated to the tongue base, and the wound is closed in two layers.
- A sterile dressing is applied to the neck, and care of the patient is returned to the anesthesiologist for extubation and recovery.
- Patients may be discharged on the day of surgery or monitored overnight depending on age, general health, and access to health care facility.
- If present, the drain can typically be removed on postoperative day 1.
- Diet may be resumed as tolerated, unless the pharyngeal mucosa was violated during the procedure.
- Incomplete excision or cyst recurrence
- Neck hematoma or seroma
- Injury to local structures, including superior laryngeal, lingual, or hypoglossal nerves
- Wound infection