Thyroglossal Duct Cyst (Fistula) Resection

The thyroid gland cyst () is the result of the atrophy closure of the thyroid gland in the embryonic period. Where the thyroid embryo base development path (such as the tongue root, the hyoid bone, the sublingual bone and the neck) can occur, located in the midline, but also in the midline, thyroid gland cyst or infection rupture into the sputum should be resection. Applicable to thyroid gland cysts or infections. Treatment of diseases: nodular goiter, thyroid gland cyst and fistula Indication Applicable to thyroid gland cysts or infections and ulceration should be removed. Contraindications There are serious obstacles to the coagulation mechanism. High blood pressure, diabetes, and some bleeding-prone diseases. Preoperative preparation 1. Treatment of oral infections (such as dental caries, tonsillitis); cysts ruptured into sputum and snoring, should be anti-infection, surgery after the inflammation subsided. 2. Use 3% boric acid water to contain strontium 3 days before surgery. 3. The lower part and neck skin are prepared regularly. Surgical procedure 1. Position: supine position, the upper body is raised 20°, and the under-shoulder cushion makes the neck stretched out to fully reveal. 2. Incision: The incision takes the middle part of the lower part of the hyoid bone as a midpoint, and the skin folds as an arc-shaped incision; or a fusiform incision centering on the cyst (). 3. Exposure and separation of cysts: After incision of the skin and platysma, the upper and lower flaps are opened with an automatic thyroid gland, and the thyroid gland cyst is exposed on the anterior or posterior side of the sternohyoid muscle. Under normal circumstances, first separate the cyst below, separate it from the thyroid tissue; use the tissue forceps to lift the cyst, continue to separate the sides of the cyst, you can see a fiber band connected to the thyroid isthmus; then separate upward, you can see the fiber band through the tongue The bone extends in the posterior direction. 4. Remove the middle part of the hyoid bone: sharply separate the muscle attached to the middle part of the hyoid bone, pull it up and down, and then cut off the hyoid bone, cut it about 1cm, and bring it together with the fiber band of the thyroid gland cyst; continue upward Look for fiber bands to prevent cyst recurrence or spasm formation. 5. Excision of the lingual part of the tongue of the thyroid gland: After the hyoid bone is cut, it is often found that the fistula is connected upward to the blind hole of the tongue. At this point, the assistant can use the index finger to extend into the patient's mouth, and push the blind hole to the incision direction, so as to continue to separate the fistula, trace it to the root as much as possible, ligation and complete resection. The assistant indicates that the direction of extrusion should be at an angle of 45°, and the hyoid bone should be about 2.5 cm from the base of the tongue. Do not trace too deep to avoid damage to the oral mucosa. 6. Stitching: If the bottom of the mouth has been cut, several needles are intermittently sutured with absorbable sutures. After rinsing the wound, the hypoglossal muscle is sutured in the midline (the suture is not sutured), and the platysma and skin are sutured layer by layer. 7. Drainage: If the bottom of the mouth is incision, or the original fistula is infected, the surrounding adhesion is heavier, there is more bleeding during surgery, and the wound has a built-in rubber sheet for drainage. complication Periosteal injury of the thyroid gland and nerve injury in the larynx, postoperative hemorrhage, hematoma of the mouth caused by 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.