THYROGLOSSAL
DUCT CYST (TGDC)– WHEN IS SURGERY INDICATED?
Surgery is
indicated in patients with TGDCs, unless the patient is not a surgical candidate.
The Sistrunk procedure is the surgical operation of choice. If a TGDC is not
removed, up to 50 % of them will be complicated by infection. Infection before
surgery increases the risk for recurrence (x 5 up to x 10). Therefore, surgery
should be performed at first presentation. If a TGDC is infected, initial
management should be conservative with antibiotic administration, following by
definitive surgery once the infection has resolved (typically after 6 weeks). Since
TGDCs are often associated with thyroid ectopia (in about 50 – 60 %), it is
essential to determine before surgery whether patients with TGDCs have ectopic
thyroid tissue, which could be involved with benign or malignant thyroid
disease. This tissue should be located before surgery by ultrasonography and
thyroid scan. Potentially coexisting thyroidopathy should be treated at the
time of the Sistrunk procedure. Carcinoma within a TGDC is extremely rare (<
1 %).
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