2.1

Demographics and perioperative characteristics

The present series involved 30 consecutive patients who underwent a Sistrunk procedure with some refinement (see below) without drain placement from July 2011 to January 2013. None of the patients had previously undergone corrective surgery, and all had a pathologic diagnosis of thyroglossal duct anomaly. Medical records were reviewed to document patient demographics, perioperative characteristics, surgical outcomes, and complications. Age-matched control group patients ( N = 21) who had surgical drains placed with their Sistrunk procedures were also identified ( Table 1 ). An institutional review board approval was obtained for this study.

Mean age at surgery was 7.4 years (range of 4 to 14 years) for the study group; 18 patients (60%) were males. Most children (93%) had unremarkable medical history (American Society of Anesthesiologist class I). Twenty-one presented with an asymptomatic lesion; the other nine had at least one episode of infection involving the thyroglossal duct cyst. All nine patients were treated with antibiotics, while two also required incision and drainage procedures. Similar characteristics were observed in the control group. All patients were previously healthy and eight had preoperative infections of their thyroglossal duct cyst ( Table 1 ).

All patients in both groups had preoperative radiological investigations. Most (97%) had ultrasound of the neck to characterize the lesion and to assess for the presence of normal thyroid gland. Two patients referred from an outside institution had magnetic resonance imaging of the neck. All 51 patients had imaging studies consistent with thyroglossal duct cyst with a normal thyroid gland.

In the study group, the first 10 patients were admitted after their operation; the last 20 were treated as day surgery patients and were discharged home on the same day. The reason for planned admission early on, even without drain placement, was to observe for hematomas, seromas and subsequent airway compromise. As there were no major complications with these patients, a decision was made not to routinely admit after the Sistrunk procedure. For those day surgery patients, the mean time spent in the recovery room was 3.6 hours (range of 2.1 to 5.8 hours). All patients who had drains placed were admitted after their operation.

2.2

Complications

Complications were categorized into major (hematoma, laryngotomy, pharyngotomy, nerve injury, hypothyroidism, airway compromise, abscess formation, recurrence) and minor (seroma not requiring intervention, stitch abscess, local wound infection). In the study group, no major complications were observed. Three patients (10%) had minor complications, which included postoperative seroma in one patient and superficial wound infection in two patients ( Table 1 ). The wound infections were managed with oral antibiotics and warm compresses as an outpatient. Seroma was considered very mild and managed expectantly; no additional surgery or procedures were required.

In the control group, one major (recurrence) and one minor (wound infection) complication were observed ( Table 1 ). Overall, there was no statistical difference in the complication rates between the study and the control group (paired t -test, p = 0.85).

Follow up of at least 16 months was achieved in all patients.

2.3

Surgical procedure

All patients in the study group underwent the Sistrunk procedure with a minor modification as described by Maddalozzo and colleagues . Briefly, this procedure involves wide dissection of the tissues surrounding the central portion of the hyoid bone. The thyroid cartilage notch and the thyrohyoid membrane are used as the deep margin of dissection. The specimen is usually mobilized in a cephalad direction at this level to ensure wide local excision of soft tissues located inferior to and posterior to the central portion of the hyoid bone . After dividing the hyoid bone at the level of the lesser cornu bilaterally, the dissection is continued superiorly toward the foramen caecum. Wide local excision is also performed at this level with a cuff of suprahyoid and genioglossus muscles. The specimen is cross-clamped and divided deep to the foramen caecum; the stump is then oversewn. Meticulous hemostasis is achieved and the wound is thoroughly irrigated. A Valsalva maneuver is performed to ensure hemostasis prior to closure. Platysmal layer, followed by the skin, is closed with absorbable sutures without the placement of a surgical drain. Externally, the wound is dressed with Steri-Strips (3M, St. Paul, Minnesota). The mean anesthesia time was 106 minutes and the mean surgery time was 65 minutes. All operations were performed by one surgeon.