Recurrent thyroglossal duct cysts: a clinical and pathologic analysis.

OBJECTIVE To analyze, in detail, the clinical and pathological findings in a patient population that had undergone previous Sistrunk procedures for the removal of thyroglossal duct cysts, in order to identify any possible factors that could be related to recurrence after 'definitive' surgery. SETTING A large pediatric tertiary care center. METHODS A retrospective chart review was performed to include all patients treated at a single center for thyroglossal duct cysts with a Sistrunk procedure, between 1978 and 1992 inclusive. RESULTS A total of 108 consecutive patients were analyzed. We noted that the presence of recent preoperative infection of the cyst was the only statistically significant (P < 0.05) clinical difference noted between the successful and the unsuccessful surgical groups. However, pathological analysis revealed that there was a substantially greater number of multiple thyroglossal duct tracts (P < 0.05) noted in the group that failed a Sistrunk procedure. CONCLUSIONS We feel that multiple thyroglossal tracts may play an etiologic role in some recurrent cysts. Thus, a wide conservative excision, including the middle two thirds of the hyoid bone, is necessary in order to include any multiple tracts in the resection.