Do we really need to perform the original sistrunk operation when treating thyroglossal duct cysts?

Tiroglossal duktus kisti tedavisinde orjinal sistrunk ameliyatı gerçekten gerekli mi?

Engin YILMAZ,ÇAĞATAY EVRİM AFŞARLAR,AYŞE KARAMAN,İBRAHİM KARAMAN,Ismet Faruk OZGUNER,Derya ERDOĞAN,Yusuf Hakan ÇAVUŞOĞLU

Özet

Amaç: Tiroglossal duktus kisti (TGDK) çocuklarda sık görülen bir konjenital boyun anomalisidir. Tedavisi zamanla bazı modifikasyonlara u ğ ram ı ş olan ve 1920 de Sistrunk tarafı ndan tariflenen ş ekliyle cerrahi eksiz- yondur. Bu çal ı ş mayla biz kliniğ imizde TGDK veya fistülü nedeniyle opere edilen hastalar ı n klinik özelliklerini ve tedavi sonuçlar ı n ı de ğ erlendirmeyi amaçlad ı k. Materyal ve Metot: 2005 ve 2012 yı llar ı aras ı nda boyun orta hatta ş iş lik ön tan ı s ı yla kliniğ imizde tedavi edilen 48 çocuk hastan ı n geriye dönük olarak kayı tlar ı incelendi. Patoloji sonuçları neticesinde TGDK kesin tan ı sı alan 34 hasta çal ı ş maya dahil edildi. Bulgular: Hastalar ı n 17si erkek (%50) ve 17si k ı zd ı (%50). Ortanca ya ş 5,4 yı l olarak bulundu. Hastalar ı n 17sinin (%50) tedavisinde klasik Sistrunk operasyonu uygulanm ı ş olmas ı na ra ğ men, 17sinde (%50) operasyon Schlangenin tariflediğ i şekilde hiyoid kemik korpusu eksizyonu sonras ı ilave disseksiyon yapı lmadan sonlan- d ı r ı lm ı ştı . Ortalama 20,5 ay takip sonrası nda opere edilen hastaları n hiçbirisinde nüks tespit edilmedi. Tart ış ma: Hastaları m ı z ı n %50sinin tedavisinde Schlange prosedürü uygulamam ı za ra ğ men nüks saptamad ı k. Bu çal ı ş ma hiyoid kemik korpusunun eksizyonunun TGDK tedavisinde temel prensip oldu ğ unu göstermektedir.

Abstract

Background: Thyroglossal duct cyst (TDC) is a common congenital midline neck anomaly among children. Although the widely excepted treatment of TDC is surgical excision as described by Sistrunk in 1920, some modifications have been implemented by the time. In this study we aimed to evaluate the clinical features and treatment results of the patients operated on TDCs in our department. Material and Methods: A retrospective review of 48 patients who had been operated for midline neck swelling in our department between January 2005 and February 2013 was conducted. Thirty-four patients with histopathological diagnosis of TDC were enrolled to this study. Results: Of the patients, 17 (50%) were male and 17 (50%) were female and the median age of the patients was 5.4 years. Though the classical Sistrunk operation was performed on 17 patients (50%), we realized that in the remaining 17 (50%) patients, the dissection was finalized immediately after the excision of hyoid bone corpus as described by Schlange. None of the patients operated for TDC had recurrent disease during a median follow-up period of 20.5 months. Conclusions: Although Schlange procedure was performed on 50% of the patients, we did not encounter any recurrences. Thus this study demonstrates that hyoid bone corpus excision is the principal component of TDC treatment.