Author(s)
Paul Bryan Hankey, BS
Jason R. Brown, DO
Affiliation(s)
Kansas City Univ., Kansas City, MO; Children's Mercy Hosp., Kansas City, MO; University of Missouri, Kansas City, MO;
Abstract:
Introduction: Thyroglossal duct cysts are the most common congenital neck mass. The present treatment of choice is transcervical excision of the cyst, tract, and the middle third of the hyoid bone, with or without removal of tongue base musculature. Complications following surgery are typically local and include persistent bleeding, seroma, hematoma, odynophagia, abscess formation, wound dehiscence, and local cellulitis. We present the case of a 3-year-old male undergoing surgical excision of a thyroglossal duct cyst that was complicated by postoperative staphylococcal toxic shock syndrome and cervical necrotizing fasciitis.
Case Description: A 3-year-old male presented to the outpatient pediatric otolaryngology clinic at our institution. Examination and ultrasound findings were consistent with a thyroglossal duct cyst. A standard Sistrunk procedure was performed. On post-operative day 2, the patient began developing fevers that quickly progressed to disseminated septic shock. Subsequent examination showed erythema and crepitus of the wound. Broad-spectrum intravenous antibiotics were initiated, and a neck exploration was performed, revealing necrotic tissue in the wound bed with thin, dishwater colored fluid. Cultures were taken and ultimately grew Staphylococcus aureus. Over subsequent days, repeat neck explorations were performed to debride necrotic tissue until adequately perfused tissue was observed in all aspects of the wound bed. The patient was discharged from the hospital on post-operative day 18 to continue intravenous antibiotics at home.
Discussion: To our knowledge, this is the first reported case of postoperative necrotizing fasciitis and staphylococcal toxic shock syndrome in a pediatric patient who underwent thyroglossal duct cyst excision. Following this experience, our division has changed how we approach surgical cases for neck mass excisions in order to decrease the risk of this complication in the future.