嚢胞造影が外科的治療に有効であった再発性正中頸嚢胞の2例

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  • TWO CASES OF RECURRENTED THYROGLOSSAL DUCT CYST IN WHICH PRE AND INTRAOPERATIVE CYSTOGRAPHY WERE USEFUL FOR RADICAL OPERATION

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We experienced two patients with recurrent thyroglossal duct cyst (TGDC) whose radical operations were facilitated by pre- and intra-operative cystography with confirmation of residual cysts and/or fistulas.<br> Case 1 involved a 52-year-old man with re-recurrent TGDC. His hyoid bone was not resected at the initial operation. In spite of cystectomy with hyoid bone resection at the second operation, recurrence appeared again. Case 2 involve a 28-year-old man who had been repeatedly treated by incision and drainage whenever abcess formation and high fever developed due to infection of TGDC. At the last operation he underwent a cystectomy without resection of the hyoid bone.<br> Preoperative cysto- and fistelography using 60% Urographin and intraoperative cysto and fistelography using Pioctanin for these two cases greatly contributes to recognize the residual cystic lesions and fistulas. There procedure consequent by facilitated the radical operation for them.<br> In a review of our previous 23 cases of recurrent TGDC at the department, these lesions were predominantly found between hyoid bone and thyroid cartilage, in a frequency of 86.9%. However, in these two cases, their lesions were located in more proximal site to the foramen cecum. Recurrence of the disease often occurs in patients whose hyoid bones are not resected and who are associated with infection at the initial operation, but it can be seen in those whose hyoid bones are resected. The causes may be residual tiny cysts and fistulas. Cystography and fistelography performed in the two cases were useful to determine the residual cysts and fistulas spreading to foramen cecum linguae after resection of the hyoid bone.<br> In conclusion, pre- and intraoperative cystography and fistelography are useful methods not only for radical operation of recurred TGDC but also for the initial operation of TGDC.

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