Doxycycline: A sclerosant agent to treat a case of recurrent thyroglossal duct cyst.

Thyroglossal duct cyst (TGDC) is one of the most common congenital anterior midline neck masses in children. Sistrunk operation is considered as the cornerstone in TGDC removal. Nevertheless, 5% to 7 % of patients have been reported to show a recurrence even after adequate resection. This necessitates at times multiple resections with potential complications. One interesting emerging technique is sclerotherapy of TGDC remnants post resection. We present here a case of a child who had a successfully treated recurrent TGDC using sclerotherapy with doxycycline.

Surgical management outcomes of recurrent thyroglossal duct cyst in children--A systematic review.

OBJECTIVES: Management of recurrent thyroglossal duct cysts (TGDC) remains a clinical challenge to otolaryngologists--head and neck surgeons. The purpose of this systematic review is to determine the best surgical management for recurrent TGDC. METHODS: A comprehensive search for relevant articles was carried out on electronic databases named Ovid Medline, Ovid Medline in process and Other Non-Indexed Citations, Embase, Ovid OldMedline, and Ovid Medline Daily. Articles published in English until 2014 were eligible for review. Using predefined inclusion criteria, published articles on surgical outcomes in the management of recurrent thyroglossal duct cyst, were selected, reviewed, and their findings synthesized. RESULTS: Nine studies met the inclusion criteria for this systematic review comprising a total of 66 patients who underwent 114 secondary surgeries. Better outcomes were observed with en bloc neck dissection vs. a revision Sistrunk with a recurrence rate of 20% vs. 30.12% respectively. In addition two new surgical approaches, suture-guided transhyoid pharyngotomy and Koempel's suprahyoid technique reported 100% success rate. CONCLUSION: Recurrence after primary surgical management remains a clinical challenge. We highlight the outcomes of the 4 main surgical techniques reported in the literature, repeat Sistrunk procedure, en bloc neck dissection, suture-guided transhyoid pharyngotomy, and Koempel's suprahyoid technique. Although this review reports a 100% success rate with the 2 latter techniques, further prospective studies and additional experience with these same techniques by other surgeons/institutions with or without a randomized trial could provide additional confirmation of improved outcomes using these specific surgical procedures.

The effect of fractionated radiotherapy in sensorineural hearing loss: an animal model.

OBJECTIVES/HYPOTHESIS: The purpose of this study is to assess the effect of fractionated radiotherapy on sensorineural hearing loss using an animal model. STUDY DESIGN: In vivo animal study. METHODS: Ears of 25 guinea pigs were divided into three groups: control, irradiated with a total of 48 gray (Gy), and 71 Gy. Unilateral exposure of 48 Gy and 71 Gy fractionated irradiation was given for a 4-week period. Auditory brainstem response and distortion products otoacoustic emissions (DPOAE) were tested prior to irradiation and 1, 6, 10, and 16 weeks after completion of radiotherapy to assess the hearing threshold shift postradiotherapy over time. RESULTS: No significant differences in hearing thresholds between the low dose radiation (48 Gy) and the control group (no radiation) underlined that 48 Gy caused no hearing deficits (P = 0.37). The higher dose (71 Gy) showed progressive deterioration of the hearing function over time. Three-way ANOVA interactions revealed significant group-time effects (F= 9.261; P < 0.0001). DPOAE analysis demonstrated hearing loss at 71 Gy without progression or recovery at all time points, predominantly in the higher frequencies tested. CONCLUSION: The present study suggests that in the presence of sensorineural hearing loss due to high- dose fractionated radiotherapy, there is an initial sensorial component; however, the neural component is responsible for its progressivity.