Author(s)
Julianna C. Kostas, BA
Bracha Sachs, MS
Sallie M. Long, MD
Joshua Sturm, MD, PhD
Jonathon O. Russell, MD
Victoria Banuchi, MD, MPH
Affiliation(s)
Weill Cornell Medical College; New York Medical College; New York Presbyterian Hospital; Johns Hopkins University; Weill Cornell Medicine;
Abstract:
Introduction: Thyroglossal duct cysts (TGDC) are congenital abnormalities that are traditionally excised via a transcervical Sistrunk procedure, leaving an external scar that can impact patient satisfaction. The transoral endoscopic vestibular approach has been established in the literature for thyroidectomy (TOETVA), but its adaptation to other neck surgeries is sparsely reported.
Methods: We describe the case of a healthy 56-year-old female who presented with a 2.4 cm TGDC. The patient had a strong preference to avoid a scar and chose to proceed with the transoral endoscopic vestibular approach to the Sistrunk. In brief, a central gingivobuccal and two mucosal oral commissure incisions were made. Hegar dilators were used in a subplatysmal plane through the central incision. The subplatysmal plane was developed and the ensuing pocket was insufflated to 6 mmHg. The TGDC was dissected from underlying musculature and needle aspiration of the cyst was performed to facilitate excision. Bone cuts were made using the Sonopet® ultrasonic aspirator, leaving a 1.5 cm segment of hyoid adjacent to the specimen. Further dissection continued and the specimen was removed in an Endo Catch™ bag.
Results: The patient was discharged home on the same day. A pressure dressing was removed after 24 hours. There were no surgical complications and she was recovering well at her first postoperative visit. Submental sensation was noted to be intact.
Conclusions: This is one of the first reported cases of the transoral endoscopic vestibular approach to the Sistrunk procedure. The TGDC was successfully excised, and the patient avoided an external neck scar. This case demonstrates that experience with the TOETVA can be adapted for use in Sistrunk procedures. More reports are needed for outcome data including the risk of recurrence following this novel approach.