Thyroglossal duct cysts: presentation and management in children versus adults

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Abstract

Objectives: To determine if the clinical presentation of thyroglossal duct cysts (TGDC) varies between children and adults and whether this knowledge helps optimize the surgical management. Methods: We retrospectively identified all patients with TGDC managed in our department between 1992 and 2002. We reviewed the patients’ charts and recorded their gender, age at diagnosis, clinical presentation, radiologic imaging, surgical management, post-operative complications, and recurrence rate and compared the variables between the children and adults. Results: Twenty-one children and 41 adults were treated for TGDC. Of the children, 57% were male and 43% were female, whereas 49% of the adults were male and 51% were female (P=0.53). The average age was 6±5 years in children and 45±16 years in adults, which demonstrates a bimodal distribution. Forty-three percent of children and 42% of adults presented with an infected neck mass (P>0.99). Among our patients, 96% of the adults and 100% of the children underwent a Sistrunk operation. Four children developed a wound infection that resolved with antibiotics. One adult developed a haematoma and another developed a wound seroma. There was one recurrence among adults and one among children, both of whom were treated with a second Sistrunk procedure. Conclusions: There appears to be a bimodal distribution for age at presentation of TGDC. Since the differential diagnosis among adults is broader, the opportunity for misdiagnosis is greater. However, once the correct diagnosis is made, the surgical management and post-operative outcome between adults and children is the same.

Introduction

A wide variety of neck masses are encountered in clinical practice (Table 1). Among these multiple pathologies, thyroglossal duct cysts (TGDC) are the most common non-odontogenic cysts of the neck and the most common midline neck masses. The exact incidence of TGDC is unclear, but its incidence appears to be equal in both genders and is presumed to be higher in children than adults [1].

The clinical presentation of TGDC in children has been very well described [2]. Adult patients may have a more insidious presentation and the differential diagnosis is wider, thus making the diagnosis of TGDC more difficult. There are no reports in the literature describing the differences in clinical presentation between adults and children. The knowledge of these differences could potentially be helpful in the management of both of these groups presenting with TGDC.

We performed a retrospective chart review of all the cases of TGDC managed in our department in the last 10 years to determine if the clinical presentation of TGDC varies between children and adults and whether this knowledge helps optimize the surgical management. For the first time, we contrast the presentation, treatment and complications associated with TGDC in adults and children.

Section snippets

Patients

We performed a retrospective chart review to identify patients treated for TGDC in the Department of Otolaryngology and Communicative Disorders at the Cleveland Clinic Foundation between 1992 and 2002. Using billing numbers, 70 charts were identified and 63 were available for review. After reviewing the 63 charts, we found that 62 contained the diagnosis of TGDC. Thus, 62 patients were included in the study. The charts were reviewed, and the following information was recorded: age at diagnosis,

Patient demographics

Of the 62 patients, 41 were adults and 21 were children. There were an approximately equal number of males (52%) and females (48%) in the overall population. In the adult group, there were 20 males and 21 females, and in the pediatric population, there were 12 males and 9 females. The average age at diagnosis was 32±22.7 years in the overall population, 45±16 years in the adult group, and 6±4.5 years in the pediatric group. Presenting symptoms are shown in Table 2. One pediatric patient had a

Patient demographics

In accord with the literature, we report an equal incidence of TGDC in males in females. However, contrary to previously described demographics [4], [5], [6] and commonly held beliefs, we report a high incidence of TGDC in adults. These findings are not altogether unusual because a number of other studies have also reported similar results, and these numbers may be directly influenced by local demographics [7], [8], [9], [10], [11], [12]. Furthermore, close examination of the meta-analysis

Conclusion

In our study, the incidence of TGDC was equal in males and females and had a bimodal distribution with similar incidence in children and adults. The results of our study suggest that contrary to current opinion, the incidence of TGDC may not be greater in children, although the incidence is generally higher in the first decade of life. However, these results may reflect biases due to referral patterns or may be just statistical noise in a small series. Although mass and infection were the most

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