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In reference to endoscope‐assisted transoral removal of a thyroglossal duct cyst using a frenotomy incision: A prospective clinical trial
Author(s) -
Bakshi Satvinder Singh
Publication year - 2016
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25700
Subject(s) - endoscope , thyroglossal duct , medicine , cyst , surgery , general surgery
I read with great interest the article titled “EndoscopeAssisted Transoral Removal of a Thyroglossal Duct Cyst Using A Frenotomy Incision: A Prospective Clinical Trial” by Woo et al. published in your esteemed journal. The study is very novel and thought provoking, and I would like to commend the authors for it. However, I have some reservations regarding the authors’ conclusion, which I would like to highlight through your prestigious journal. Endoscope-assisted removal of lingual thyroid and thyroglossal cyst with submental incisions has been described previously, but endoscopic transoral resection is novel and has been described in only few isolated case reports. The cosmetic advantage of this technique is very appealing. However, what is of concern is the risk of recurrence of the thyroglossal cyst. The rate of recurrence varies from 4% to 10% with conventional Sistrunk surgery. The reasons for recurrence are multiple, with some of them being the presence of multiple tracts or leaving behind some part of the tract. Transoral removal of the thyroglossal cyst may not be able to remove all of these tracts, and there may also be some chance of leaving some part of the tract behind, consequently increasing the risk of recurrence. One more thing we must keep in mind is that the recurrence of thyroglossal cyst can occur even years after surgery; hence, a longer follow-up of patients undergoing this novel technique is required before a definite conclusion can be arrived at. There are few more issues, such operative duration, learning curve, availability of expertise, cost effectiveness, and management of postoperative complications, especially hematoma, which need to be evaluated in future studies before recommending endoscope-assisted transoral removal as a standard of care. Endoscope-assisted transoral removal of thyroglossal cyst is an exciting option; however, I would recommend judicious selection of cases before trying this technique. I would like to stress that those patients with risk factors for recurrence, such as infected cyst, should be operated on only by the conventional technique. Future randomized clinical trials should be designed comparing the endoscope-assisted transoral technique and Sistrunk surgery for thyroglossal duct cysts with long-term follow-up for determining the best modality.