Sistrunk Procedure Steps, Surgery, Complications, Recovery

There are certain individuals who are born with a little, soft bump in the center of their throats. These bumps, which can be seen as well as felt, are referred to as thyroglossal duct cysts (TDC). Most of the time, these cysts are tiny and measure approximately 2 centimeters (cm) in diameter. Additionally, they are infrequent, often affecting only 7% of Americans.

Cysts of the thyroglossal duct can afflict both children and adults, however, the majority of cysts are discovered in children under the age of 10. These cysts are generally noncancerous; less than one percent of thyroglossal duct cysts are malignant. Children have a lower risk of developing TDC cancer compared to adults. Surgical intervention is used to treat thyroglossal duct cysts. Once removed, the majority of thyroglossal cysts do not reappear.

What is Sistrunk Procedure?

The Sistrunk procedure is a popular approach chosen for the surgery of a thyroglossal duct cyst, particularly for those who are considered low-risk patients. On the other hand, total thyroidectomy in conjunction with radiation iodine ablation needs to be taken into consideration for high-risk individuals. There are divergent views on the best course of action to take in this circumstance because thyroglossal duct cyst cancer is so uncommon.

Sistrunk Procedure Steps, Surgery, Complications, Recovery

Sistrunk Procedure Steps

  • An incision is made horizontally down the neck at the position of the hyoid bone. This incision is called a transverse incision. 
  • The length of the incision is roughly 5 centimeters.
  • The cyst, which is often located behind the raphe that links the sternohyoid muscles, is exposed by exploration of the skin and the platysma muscle.
  • Once the hyoid bone is reached, the cyst is removed from the nearby muscles and tissues by means of dissection.
  • At the hyoid bone, the muscles that attach to the center of the bone are excised and detached, followed by the removal of a 2-centimeter segment of the center of the hyoid along with the cyst and tract.
  • A core of tissue is then excised as necessary from the superior portion of the hyoid bone to the area of the foramen cecum. The core of the tissue that surrounds the thyroglossal duct has a diameter of roughly one centimeter.
  • As part of the Sistrunk procedure, the foramen cecum, a portion of each genioglossus muscle, and the raphe connecting the mylohyoid muscles are also excised. 
  • These procedures are now only carried out when absolutely necessary and are determined by the position of the cyst in relation to the thyroglossal tract.

Sistrunk Procedure Surgery

  • Excision of thyroglossal cysts was described by Dr. Walter Ellis Sistrunk as the "classic procedure" in the year 1920.
  • The Sistrunk procedure requires the removal of the cyst in addition to the path's main tract and any branches it may have.
  • It is necessary to remove the middle section of the hyoid bone to enable full excision of the tract.
  • This procedure, which was established on an understanding of the anatomy and physiology of the thyroglossal duct cyst, resulted in a significant improvement in patient outcomes.
  • The recurrence rate for thyroglossal cysts is lowered from 50% to 10% when the Sistrunk procedure is used to fix the problem.
  • The likelihood of a recurrence following such a procedure is low.
  • The sistrunk procedure can either be conducted as a day-stay or an overnight-stay procedure and requires general anesthesia.
  • Prior to surgery, thyroid imaging and thyroid function tests are required.
  • The Sistrunk procedure must be used in order to remove not only the cyst but also the path's main tract and any branches. This is necessary in order to achieve a permanent surgical cure.

Sistrunk Procedure Complications

A relapse of the thyroglossal duct cyst is the most prevalent problem that might arise from the Sistrunk procedure. This issue manifests itself in approximately 10% of all cases. 

Recurrence is influenced by inadequate excision, intraoperative perforation, surgical competence and expertise, and infection. After technically sound operations, recurrence is still possible.

A rare but potentially fatal side effect of the Sistrunk procedure is laryngotracheal damage, which affects the airway, swallowing, or vocal area. It may result from incorrectly removing the thyroid cartilage rather than the hyoid bone. To avoid this during surgery, it is crucial to correctly identify the hyoid bone, thyroid cartilage, and thyrohyoid membrane.

Sistrunk Procedure Recovery

The majority of adult patients need to rest for 5 days after surgery. The removal of the middle section of the hyoid bone will make swallowing painful and possibly "strange". In the event that a drain was positioned in the operating theatre, it should be removed the next morning after the procedure. After the bandage is taken off, the scar is left open to naturally heal. There are no stitches that need to be removed; instead, steri-strips of tape will be applied over the skin incision.

Sistrunk Procedure Steps, Surgery, Complications, Recovery Sistrunk Procedure Steps, Surgery, Complications, Recovery Reviewed by Simon Albert on November 15, 2022 Rating: 5
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