Thyroglossal duct cyst and fistula resection

The thyroglossal cyst and the thyroglossal sinus resection are used for neck cyst and fistula surgery. The thyroid gland cyst is caused by congenital dysplasia. If the cyst is located at the base of the baby's tongue, it may cause suffocation. The thyroid gland passes down the lingual bone to the thyroid gland. The cysts occur in the tongue between the blind hole and the hyoid bone, between the hyoid bone and the throat, and in the lower part of the trachea. The thyroid gland cyst or the thyroglossal fistula often forms more scar tissue due to repeated infections, which makes it difficult to completely remove the diseased tissue. Juvenile patients are incompletely developed due to incomplete tissue development and are prone to recurrence after surgery. Treatment of diseases: thyroglossal cyst Indication A thyroid gland cyst or sputum should be surgically removed if there is no acute inflammation. However, young children should be operated after 2 years of age. When a cyst is infected to form an abscess, it is necessary to first open the drainage. When the inflammation subsides and the fistula is formed, the fistula resection is performed. Preoperative preparation Iodine angiography should be performed if necessary to understand the exact depth of the fistula. Surgical procedure 1. Incision A transverse incision is made in the neck, the incision passes through the surface of the cyst, and the ends are slightly curved upward. In the case of a fistula, a transverse fusiform incision is made around the fistula to remove the adhered skin around the fistula. The length of the slit is generally 4 to 5 cm. If the position of the fistula is low, a second incision can be made in the plane of the hyoid bone. Before the operation begins, 1% methylene blue can be injected into the cyst or fistula to facilitate the identification of the fistula during surgery. 2, separation A cyst or fistula can be revealed by cutting the skin, subcutaneous tissue and platysma along the incision design line. Separate along the surface of the fistula or cyst directly to the hyoid bone. Because the cyst or fistula often adheres to the thyroid gland muscle, it should be carefully separated to avoid damage to the deep thyroid periosteum in the muscular layer. Because the nerve in the larynx travels to the outer part of the periosteum of the thyroid tongue, the outer part of the cyst should be separated from the wall of the cyst and carefully separated. Be careful not to damage the nerve inside the larynx. 3, cut the hyoid bone When separating the cyst or fistula to the lower edge of the hyoid bone, on both sides of the cyst or the junction of the fistula and the hyoid bone (both sides of the middle part of the hyoid bone), the periosteum and its muscles are cut open, and the hyoid bone is cut with a bone scissors. At the time, the cyst or fistula and the middle segment of the hyoid bone can be released together. The cut tongue is about 1 cm long. 4, remove the fistula Above the hyoid bone, the muscle fibers of the mandibular ligament muscle are cut along the midline, and the genioglossus muscle is separated. The assistant pushes the index finger into the base of the patient's tongue, pushing the blind hole to the front, shortening the distance from the blind hole to the hyoid bone, and facilitating the distance. Surgical operation. Then gently lift the middle part of the hyoid bone and the cyst or fistula connected to it, and cut the fistula together with the 2~3mm muscle tissue around it for columnar tissue, directly to the blind hole, cut off after the base is ligated, or the whole pipeline It is removed together with the inner port at the blind hole. The root of the tongue is sutured with the gut, and the muscle layer below it is sutured several times. 5, stitching After flushing the wound cavity and completely stopping bleeding, suture the muscle layer in the wound cavity, place the rubber drain strip, and then suture the platysma, subcutaneous tissue and skin. complication The main complications of the glandular gland cyst and hernia resection include thyroid hyaline periosteum injury and intralaryngeal nerve injury. Postoperative hemorrhage and oral hematoma lead to upper airway obstruction and postoperative recurrence. The causes and preventive measures for these complications are as described above. It should be emphasized that postoperative attention should be paid to the observation. If the bottom of the mouth is swollen, it should be treated promptly. If necessary, an emergency tracheotomy should be performed to prevent suffocation.