Ultrasound imaging of thyroglossal cysts of the neck to the hyoid bone

Аннотация

Сysts of the neck are congenital cystic lesions of the neck, often presenting in childhood. Complete surgical excision is the treatment of choice for these lesions. Recurrence of cystic lesions of the neck after incomplete excision is fraught with complications due to the need for a second surgery and complications of the recurrent cyst itself. We herein report the de- tails of recurrent cysts of the neck presenting at 3, 6, 12 and 18 months postoperatively. Keywords: Сysts of the neck, ultrasound, MRI, recurrence, complications (Received April 7, 2021; Accepted September 8, 2021) thyroglossal cysts (TGCs), which necessarily have their Introduction own internal fistula, and are the main cause of recurrence of TGCs of the neck. However, while such a definition is Neck cystic masses are fairly frequent developmental easy for operating surgeons to comprehend, it is not quite defects, and surgery is the only method of treatment, with accurate with regard to the topographic anatomy2). early intervention usually recommended to avoid com- Monitoring neck cysts is important for predicting the plications1). As a rule, in surgical practice, there are three appropriateness of a given treatment and determining the surgical approaches to excising cysts: surgical excision of likelihood of recurrence. Ultrasound provides a simple the thyroglossal duct, simple excision of the cyst alone, or and cost-effective solution to this problem, but it is im- excision in accordance with the Sistrunk procedure. The portant to take into account the presence of the distal Sistrunk procedure was introduced by W. E. Sistrunk parts of the internal ducts of the neck cyst. As ultrasound in 1920 and involves resection of the cyst, tract, median lacks the ability to obtain a three-dimensional image, it part of the hyoid bone, and cuff surrounding the base of is in many ways inferior to MRI. the tongue musculature. In this study, the utility of sonography and MRI for Magnetic resonance imaging (MRI) is an estab- monitoring recurrence of cystic formations of the neck lished method of monitoring and evaluating the treat- was evaluated. ment of cystic neck formations in everyday practice. Postoperative scars can also become inflamed, repre- Material and methods senting one cause of recurrent neck cysts2-5). The most frequent complication of such cysts is an infection, which Ultrasound and MRI were used to monitor for recur- in most cases leads to complete and incomplete fistulas, rence of cystic formations of the neck in 19 patients at 3, abscesses neck, abscesses, and low-current pyoinflam- 6, 12 and 18 months after an operation. TGCs were veri- matory processes, such as local infiltration and lymph- fied in 15 (78.9%) patients, and branchiolic cysts of the adenitis3). There are typically anatomical variants of neck were noted in 4 patients (21.1%). Relapse in 7 (36.8%) patients occurred after non-radi- cal surgery in the volume of only the removal of the cys- Corresponding Author: Toru Aoyama, Department of Surgery, Yokohama City tic cavity itself, without resection of the hyoid bone body, University, 3-9 Fukuura Kanazawa-ku, Yokohama, Japan. E-Mail: t-aoyama@lilac. plala.or.jp confirmed earlier by morphological examination-TGCs. Sonography and magnetic resonance tomography of neck cysts 131 Table 1 Background of 19 patients Patient Internal Regional Age Sizes Contours Shape Cyst walls Type of resection Number structure LAP 1 12 y/o 1.5×1.2×1.8 Rough, fuzzy Rounded Thickened heterogeneous /+ Resection by Sistrunk 2 36 y/o 2.3×1.5×1.2 Smooth, clear Awry Thickened Homogeneous /− Conventional cystic cavity resection 3 52 y/o 2.1×0.8×1.5 Smooth, clear Awry Thickened Homogeneous /− Conventional cystic cavity resection 4 12 y/o 0.8×0.5×1.0 Rough, fuzzy Rounded Thickened heterogeneous /+ Resection by Sistrunk 5 10 y/o 0.5×0.7×0.9 Rough, fuzzy Rounded Thickened heterogeneous /+ Resection by Sistrunk 6 12 y/o 1.2×1.5×0.8 Smooth, clear Awry Thickened Homogeneous /− Conventional cystic cavity resection 7 26 y/o 0.5×0.6×1.2 Rough, fuzzy Rounded Thickened heterogeneous /+ Resection by Sistrunk 8 10 y/o 0.3×1.2×0.8 Rough, fuzzy Rounded Thickened heterogeneous /+ Resection by Sistrunk 9 18 y/o 2.8×1.4×1.5 Rough, fuzzy Rounded Thickened heterogeneous /+ Resection by Sistrunk 10 25 y/o 2.0×1.8×1.3 Smooth, clear Awry Thickened Homogeneous /− Conventional cystic cavity resection 11 20 y/o 1.3×0.8×1.6 Smooth, clear Awry Thickened Homogeneous /− Conventional cystic cavity resection 12 29 y/o 0.8×1.4×1.2 Rough, fuzzy Rounded Thickened heterogeneous /+ Resection by Sistrunk 13 13 y/o 0.6×0.9×1.1 Rough, fuzzy Rounded Thickened heterogeneous /+ Resection by Sistrunk 14 14 y/o 0.5×.08×.1.0 Rough, fuzzy Rounded Thickened heterogeneous /+ Resection by Sistrunk 15 12 y/o 1.8×1.6×0.9 Rough, fuzzy Rounded Thickened heterogeneous /+ Resection by Sistrunk 16 12 y/o 1.4×1.3×1.1 Rough, fuzzy Rounded Thickened heterogeneous /+ Resection by Sistrunk 17 11 y/o 1.0×1.1×1.0 Smooth, cl