Editing Thyroglossal duct (section)

== Sistrunk procedure: ==

* Preparation:
* Principles:
** En bloc resection of cyst and duct remnants, and part of hyoid if necessary
* Technique:
** Elliptical transverse skin incision over sinus/cyst
** Sub-platysmal flaps
** Open midline raphe between straps
*** If there are chronic adhesions to surrounding tissues like straps, take a cuff to avoid leaving cyst behind
** Dissect cyst and duct
*** Resect attachments to pyramidal lobe if present
*** Continue upwards until hyoid bone
** Hyoid resection
*** Skeletonise the hyoid on location of planned cuts
*** Release infra-hyoid straps from underside for these areas
*** Clear posteriorly as well but don't enter pharynx
*** Divide just medial to lesser cornu on each side
*** Use bone cutters to excise this segment of bone, keeping it in continuity with the tract
** Then grasp middle segment of cut hyoid with Allis and continue following up
** Dissect to foramen caecum
*** May not be able to feel or see much above hyoid
*** Can have an assistant put a finger in the mouth and push the base of tongue
*** Ideally, ligate just below the foramen caecum
** Haemostasis
** Wash and leak test to exclude pharyngotomy
** Small drain?
** Reapproximate straps, platysma and skin
* Complications:
** Lingual nerve injury
** Recurrence
** Hypothyroidism!

[[Category:ENT]]