Analysis of the curative effect and risk factors for recurrence of modified Sistrunk procedure on thyroglossal duct cyst in children

Analysis of the curative effect and risk factors for recurrence of modified Sistrunk procedure on thyroglossal duct cyst in children | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of the curative effect and risk factors for recurrence of modified Sistrunk procedure on thyroglossal duct cyst in children Ge Zhang, Xiaodan Li, Jinsheng Hao, Jie Zhang, Yanzhen Li, Xuexi Zhang, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3133237/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives The present study aimed to retrospectively summarize the optimization experience of the modified Sistrunk (mSis) procedure, analyze the curative efficacy of this procedure in the treatment of children with thyroglossal duct cyst (TGDC), and investigate the related risk factors for recurrence. Methods A retrospective analysis was conducted on children undergoing mSis procedure from March 2012–December 2021. Based on our practical experience, the mSis procedure has been optimized in the following details: the resection at the cartilaginous joint of hyoid bone, core out to the foramen cecum, and the resection and ligation techniques of the fistula near the foramen cecum. Medical history, physical examination characteristics, ultrasound characteristics, and prognosis were evaluated by regression analysis. Results Of the 391 children with TGDC, the recurrence rate was 2.30% and the recurrence time ranged from 0.5–34 (average, 7.2) months after the procedure. During the follow-up, 10 children had local wound infection but no recurrence and none had other complications. In the Poisson regression model, the p -values of the three factors of clearness of lesion boundary, surgical history, and lesion diameter were < 0.05 and the relative risk (RR) values corresponding to the above three risk factors, such as Exp (B), were 27.918, 10.054, and 6.606, respectively. Conclusion The present study made optimizations based on the previous mSis procedure and integrated the complete resection and less injury. Thus, the procedure was safe and effective with fewer complications and a low recurrence rate. In addition, the indistinct lesion boundary, surgical history, and large lesion diameter were independent risk factors for disease recurrence. Level of Evidence: IV thyroglossal duct cyst congenital neck mass pediatric Sistrunk procedure Figures Figure 1 Introduction Thyroglossal duct cyst (TGDC) is the most common congenital cervical malformation, accounting for approximately 70% of midline neck masses in children. It usually occurs in childhood within 10 years of age, albeit the age of onset is < 5 years, and no significant sex-related difference was observed[ 1 ]. The lesions of the thyroglossal duct originate from the incomplete degeneration of the channel formed by the decline in thyroid tissues during embryonic development, and the secretions of the residual ductal epithelium are accumulated to form cysts. A fistula is formed when a cyst has secondary infection or ruptures to the surface of the skin. Clinically, it manifests as an asymptomatic enlarged neck mass, which can be located anywhere from the submental area to the suprasternal notch and moves up and down with swallowing or an extended tongue. In case of infection, there are secretions at fistula orificium. Ultrasonic examination, computed tomography (CT), and magnetic resonance imaging (MRI) differentiate TGDC from other neck masses, such as dermoid cysts, lymph nodes, and ectopic thyroid[ 2 ]; among these methods, ultrasonography is most valuable in children. Notably, “fistula” formed by infection and rupture is a draining sinus tract. The embryological entity is the same as TGDC, but is often described separately due to varied clinical manifestations[ 3 ]. To date, surgical resection remains the most effective treatment option for TGDC. Except for lingual TGDC (the cyst is located at the root of the tongue, accounting for about 0.6–3%[ 4 ]) that can be treated with suspension laryngoscopy, the modified Sistrunk (mSis) procedure remains the most effective option for children with neck TGDC[ 5 ]. The TGDC removal procedure has undergone development for more than a hundred years. In 1893, Schlange proposed for the first time to remove the middle hyoid bone while removing the cyst or fistula[ 6 ]. In 1920, Sistrunk proposed to remove the middle hyoid bone and the foramen cecum, thus formulating the classic Sistrunk procedure[ 7 ]. In 1928, Sistrunk modified this classic procedure, without emphasizing the removal of the foramen cecum of the tongue, but separating it to the mucosal layer of the mouth floor, retaining the sublingual root and maintaining a sterile environment for clean incisions in the neck[ 8 ]; thus, the mSis procedure was formulated. In the current study, we modified and optimized the operational details of the previously reported mSis procedure; then, the operative details and key points of practical experience in mSis were summarized and described. Also, the efficacy of the mSis procedure and prognosis were analyzed retrospectively, and the risk factors related to disease recurrence was assessed. Materials and Methods 1. Participants This was a case-control retrospective review of all patients who underwent mSis in Beijing Children’s Hospital, Beijing, China, and Baoding Children’s Hospital, Baoding, China from March 2012 to December 2021. The inclusion criteria: children aged 0-18 who were diagnosed TGDC and underwent mSis under general anesthesia. The exclusion criteria were as follows: 1) preoperatively diagnosed lingual TGDC; 2) children with preoperative clinical diagnosis of TGDC who did not undergo mSis because the correlation between the lesion and hyoid bone was not found during the procedure. A total of 391 cases met the inclusion criteria, including 361 from Beijing Children’s Hospital and 30 from Baoding Hospital of Beijing Children’s Hospital. The cohort comprised 244 males and 147 females, and the age range was 0.76–15.02 (mean, 5.35±2.81) years. This study was approved by the Medical Ethics Committee of Beijing Children’s Hospital, Capital Medical University [No. (2022)-E-228-R]. The patients and parents were involved in selecting the procedure, and signed the informed consent form for surgery. 2. Clinical data The data of medical and family history were collected, and all children underwent general physical and special examinations of the pharynx and neck (including thyroid and lymph nodes). Neck ultrasond was a nacessary preoperative examination to evaluate the location and nature of the lesion, the adjacent correlation with vital tissues and organs, as well as the hyoid bone, status of cervical lymph nodes, and confirm that the location and morphology of the thyroid gland. At the same time, fibrolaryngoscopy were used to exclude lingual TGDC. 3. Operative procedure The operation was performed under general anesthesia. All the included children underwent standard mSis procedure carried out by the team’s deputy senior or senior chief physician. The key steps of the operation were as follows: Exposure and anatomy of the cyst: The skin, subcutaneous tissues, and platysmas were cut, and the flap was flipped. The suprahyoid and infrahyoid muscles (strap muscles) (Fig. 1a) were cut transversely above and below the cyst and the middle part of the connected hyoid bone. The fully exposed cyst was then dissected using a tungsten alloy needle electrotom to ensure accurate surgical manipulation while avoiding rupture. Cutting the hyoid bone: Allis forceps were used to lift the middle part of the hyoid bone. After releasing the attachment of the suprahyoid muscles and infrahyoid muscles, the cartilaginous junction between the hyoid body and the greater horn was resected by needle electrotom; the bilateral hyoid bone stumps simultaneously underwent electrocoagulation (Fig. 1b). The remnants of the hyoid body were removed carefully in relapsed patients. Core out to the foramen cecum: The cyst and the middle hyoid bone were lifted, and dissection continued to the upward wedge separation to lingual foramen cecum and ended at the level of mouth floor mucosa (usually the lingual muscle at the lingual foramen cecum is ring-shaped) (Fig. 1c); entering the pharyngeal cavity was avoided to prevent pharyngeal fistula. In the tongue root mucosa, the fistula was dissected with cold knife to preserve the integrity of the mouth floor mucosa (Fig. 1d). The fistula mucosal epithelium in the dissected tissues was confirmed by naked eyes. The fistula stump was sutured and ligated, and a figure-of-eight suturing was made in the deep area wherein a small potential segment of fistula was connected with the lingual foramen cecum (Fig. 1e). The figure-of-eight suturing was not too high or too deep to suture the epiglottis, and the operated cavity was closed layer-by-layer after hemostasis. 4. Follow-up The resected specimens of all patients were routinely submitted for pathological examination. All children completed the first re-examination 7–10 days after the procedure and were followed up via outpatient revisits at 1, 3, and 6 months and 1 year subsequently. The follow-up included physical examination and ultrasonography within the first postoperative year, followed by annual telephone follow-up. The possible complications, such as pain, scar, infection, mass recurrence, dysphagia, pharyngeal fistula, tongue deviation, and neck movement limitation were inquired about and focused upon during the follow-up, which ended on March 1, 2023, i.e., 15–156 (mean, 69.62±28.33) months. If cervical infection or mass recurred during the follow-up, ultrasonography was performed at the earliest. 5. Statistical methods The statistical data were compared between the two groups using SPSS for Windows v12.0 (SPSS, Inc., Chicago, IL, USA), and a p-value <0.05 was considered statistically significant. For the between-group comparison of quantitative data, the independent-sample t-test was conducted in case of normal distribution and homogeneity of variance, and the Wilcoxon rank-sum test was applied in case of non-normal distribution. A chi-square test and the Wilcoxon rank-sum test was used for the between-group comparison of binary and ranked data, respectively. In multivariate analysis, Poisson regression was used instead of multivariate logistic regression due to a large difference in the number of cases between the recurrence and the non-recurrence groups (382/9). Results 1. Demographic information and clinical characteristics A total of 391 children were included in the present study with disease course of 0.5–120 (average, 14.32±17.60) months. The clinical information of 391 children with TGDC is summarized in Table 1. The mean age of the TGDC cohort was 5.35±2.81 years, included 244 males and 147 females, and comprised 273 (69.8%) children who sought medical treatment due to neck masses and 118 (30.2%) with neck infections. Moreover, 36/391 (9.2%) had undergone surgery previously at other hospitals with the initial diagnosis of neck cyst (22), thyroglossal duct cyst (12) and branchial fistula (2), and the 36 cases underwent neck cyst and fistula resection surgery before, with only 6 cases underwent partial hyoid bone resection at the same. 2. Safety and effectiveness During the follow-up, 10 children presented local wound infection but no recurrence and only 1 child was not satisfied with incision scar, but none had other complications, such as bleeding, unplanned reoperation, unplanned intubation, pneumonia, nerve injury, dysphagia, pharyngeal fistula, tongue deviation, and limited neck movement. Regarding effectiveness, 9/391 children experienced recurrence, with an overall recurrence rate of 2.30%. Among those with recurrence, 7 had cervical masses, and 2 had redness, swelling, or pus in the neck wound. The recurrence time ranged from 0.5–34 (median=5) months after the procedure and the recurrence time of 8 children was less than 7 months. 3. Risk factors of recurrence Based on the presence or absence of recurrence, all 391 children were assigned to the non-recurrence and recurrence groups. The basic information, disease characteristics, treatment, and follow-up information of the two groups are compared in Table 1. The results indicated statistically significant differences between the groups in terms of palpable mass in the neck, the maximum diameter of the lesion, and lesion boundary under ultrasound. However, multivariate analysis was needed to eliminate the mutual interference among the factors. The LogWorth of each clinical characteristic in the multiple regression model was calculated, and each factor arranged in an ascending order based on the p-value. Based on the clinical value and statistical significance, six variables with LogWorth >1 and p-value <0.1 were included in multivariate analysis (Table 2). Due to the low incidence of recurrence and the large difference in sample size between the recurrence and non-recurrence groups (9/382), Poisson linear logarithm regression was used to evaluate the related factors of recurrence. The frequency of recurrence, consistent with Poisson distribution (Kolmogorov-Sminov Z value =0.005 and p - value =1.000 in Poisson distribution test), was used as the dependent variable, and the main effect included the top six independent variables in Table 2. The deviation value/degree of freedom in the goodness-of-fit of the model was 0.100, which met the requirement of equal discreteness; the Omnibus value of the global test was significant at 0.002. The statistically significant parameters are shown in Table 3 (independent variables with p<0.05). The results suggested that the p-values of the three factors of clearness of lesion boundary, surgical history, and lesion diameter in the model were <0.05, indicating statistical significance and deeming them independent risk factors for recurrence. Correspondingly, the relative risk (RR) values for the above three risk factors, such as Exp (B), were 27.918, 10.054, and 6.606, respectively, suggesting that TGDC children with indistinct lesion boundary under ultrasound, surgical history, and the maximum lesion diameter >2 cm were 26.918, 9.054, and 5.606 times more likely to have recurrence compared to those without the above characteristics, respectively. Discussion 1. Operation procedure Based on our practical experience, the mSis procedure has been optimized in the following details: the resection at the cartilaginous joint of hyoid bone, core out to the foramen cecum, and the resection and ligation techniques of the fistula near the foramen cecum. These detailed modifications realized the complete resection of the lesions while reducing injuries, further lowering the recurrence rate. 1.1 Operation procedures of hyoid bone. In the traditional modified Sistrunk surgery, the central body or middle third of the hyoid bone was transversely cut with the bone cutting forceps on both sides of the hyoid body. The operation procedure adapted in the present study used the needle electrotom to divide the cartilaginous junction between the hyoid body and the greater horn by combining the advantages of the anatomical characteristics in childhood. An overview of the hyoid bone discovered that until middle age, the connection between the body and the greater cornu is fibrous[9]. Therefore, for pediatric TGDC, the needle electrotom can easily accomplish the division of the cartilaginous junction between the body and the greater horn without unnecessary bleeding. A similar conclusion was reported by Ryu et al. after studying 26 pediatric patients[10]. 1.2 The tracking and anatomy of foramen cecum. It should be emphasized the importance of maintaining the en bloc principle without trying to identify a sinus tract in the region superior to the hyoid bone[11], and the cuff column of about 1-cm tissue volume was completely separated to the mucosal of lingual foramen cecum level, encompassing mylohyoid muscles and genioglossus. According to Sistrunk, the cuff diameter of tissues around the lingual duct separated along the suprahyoid bone is about 3 mm[8]. However, Horisawa et al. found extensive branches at suprahyoid and infrahyoid areas in the three-dimensional reconstruction of the thyroglossal duct[12]. In 1950, Boyd proposed that the rupture of the thyroglossal duct shortens and thickens the proximal portion, and its epithelium resembles that of the tongue and frequently re-develops a lumen from which an extensive system of branches is grown[13]. Soucy and Penning reviewed 44 TGDC pathological sections and demonstrated that the thyroglossal duct delivers many dendritic branches to the surrounding tissues[14], such that the resection range covered these hidden branch fistulae. Since the separation is deep to the mucosal layer of the foramen cecum, the cold knife should be used for dissection to avoid the possible risk of pharyngeal fistula caused by electrotom resection, affecting healing and facilitating visual observation to confirm the fistula mucosal epithelium in the resected tissues. This procedure does not enter the pharyngeal cavity, avoiding the purse string suture and adopting figure-of-eight suture to consolidate the stumps. Since fully bending backward position would cause glossocoma and tracheal intubation would be close to epiglottis and the root of the tongue, the suture should not be extremely deep. 2. Recurrence and the risk factor The sample size of previous case-control studies on the application of mSis in TGDC ranged from 24–251, and the recurrence rate was 1.6–16.1%[15, 16]. The present study has the largest sample size involving retrospective data of mSis in children, and the recurrence rate (2.30%, during 15–156-months follow-up) was lower than the average reported by other studies. Statistical analysis revealed that the distinct lesion boundary, surgical history, and lesion diameter were independent risk factors for disease recurrence. 2.1Leision boundary. In this study, the indistinct lesion boundary suggested that infection can lead to local inflammatory or cicatricial adhesions. Moreover, the duration of surgery was 2 weeks after the infection was controlled. However, the above findings indicated that although the skin surface indicated controlled infection, the internal peripheral lesions might still be in the inflammatory recovery stage of the infection. When TGDC is in the infection stage, the tissue is edematous and congested, and the fistula wall and small branches have poor elasticity and toughness and are easy to rupture when separated. Although several studies suggested an association between infection and recurrence[17-19], some reports do not support this association[20, 21]. The present findings demonstrated that the preoperative occult infection stage might affect the complete resection of the small branches and fistulas during the procedure, leading to recurrence. 3.2 Secondary surgery. For patients with surgical history of neck masses, local inflammatory or cicatricial adhesions, unclear anatomical level, and blind operation poses significant challenges for a complete resection of the cysts and fistulas in secondary surgery, leading to residual and recurrent fistulas and the formation of small branches. Kim found that even if experienced doctors used the classic Sistrunk procedure to resect TGDC, the mean recurrence rate was >4%, and re-surgery failed in 33% of recurrent patients[11]. In the present study, the failure rate of re-surgery in the recurrent patients was 5.6% (2/36), further suggesting that in children undergoing non-standard surgeries, such as simple cyst resection and non-dissection of hyoid bone, intraoperative procedures should be detailed and thorough. Perkins et al. demonstrated that if the hyoid bone was not dissected in the first surgery, re-surgery after recurrence would increase the risk of second recurrence[22]. Some studies reported a successful experience of the central neck dissection in the treatment of recurrent TGDC, expanding the resection range of Sistrunk procedure to include the anterior tracheal soft tissues to realize the en bloc resection; the width of the resected tissue volume of the strap muscles and hyoid bone was 3-4 cm and that of the foramen cecum reached 2-3 cm[23]. Moreover, no recurrence or serious complication was observed after the central neck dissection, but risks, such as damage to the internal carotid artery, vagus nerve, and entry into the pharyngeal cavity could not be ignored. These findings provided a reference to improve the efficacy in the treatment of children with recurrent and refractory TGDC after repeated surgeries. 3.3 Leision size. In addition, some researchers proposed a correlation between the cyst size and recurrence[21]. Clinically, the volume of the cyst does not change or changes slowly. If the cyst is infected, the volume increases in a short time but is reduced rapidly when the infection is controlled. The present study found that lesion diameter (>2 cm) is a major risk factor for recurrence. Thus, it is speculated that large cysts are prone to rupture during surgery and leakage into the surrounding tissues, resulting in indistinct boundaries. On the other hand, some children may still be in the recovery stage post-infection. 4. Limitations. Nevertheless, the present study has several limitations. First, due to the limited sample size, combined with the lower recurrence rate, the sample size of the recurrence and the non-recurrence groups was significantly different, causing bias in the results. Second, the follow-up time was limited. Although the minimum follow-up time of this study (15 months) was significantly longer than the recurrence time (<7 months) of most recurrent children (8/9), there may be potential relapses that may not have been found. Third, the duration for the case included in the present study was prolonged, while the experience of the mSis procedure was accumulated gradually. During continuous unification of surgical details, the surgery-related habits of different surgeons also have a potential impact on the findings. Fourth, for children with recurrence after undergoing mSis procedure, constant attention and investigation are warranted for developing therapeutic regimens, including re-resection, ultrasound-guided local injection of hardening agents, and endoscopic resection of masses at the tongue root (for those with secondary lingual TGDC), to accumulate experience. Conclusion The mSis is currently the a widely used procedure in the clinical treatment of children with TGDC. Combining the anatomical characteristics in childhood, the present study made a detailed optimization based on the previous mSis procedure and integrated the complete resection with less injury. Thus, the procedure was safe and effective with fewer complication and a low recurrence rate. In addition, the indistinct lesion boundaries, surgical history, and large diameter of lesion are independent risk factors for TGDC recurrence. For children with such clinical characteristics, the accurate operative skill of mSis procedures should be detailed and thorough in to reduce the recurrence rate. References Radkowski D, Arnold J, Healy GB, McGill T, Treves ST, Paltiel H, et al. (1991) Thyroglossal duct remnants. Preoperative evaluation and management. Arch Otolaryngol Head Neck Surg 117(12):1378-1381. https://doi.org:10.1001/archotol.1991.01870240070011 Zander DA, Smoker WR (2014) Imaging of ectopic thyroid tissue and thyroglossal duct cysts. Radiographics 34(1):37-50. https://doi.org:10.1148/rg.341135055 de Tristan J, Zenk J, Kunzel J, Psychogios G, Iro H (2015) Thyroglossal duct cysts: 20 years' experience (1992-2011). Eur Arch Otorhinolaryngol 272(9):2513-2519. https://doi.org:10.1007/s00405-014-3229-6 Sameer KSM, Mohanty S, Correa MMA, Das K (2012) Lingual thyroglossal duct cysts--a review. International Journal of Pediatric Otorhinolaryngology 76(2):165-168. https://doi.org:10.1016/j.ijporl.2011.11.025 Galluzzi F, Pignataro L, Gaini RM, Hartley B, Garavello W (2013) Risk of recurrence in children operated for thyroglossal duct cysts: A systematic review. Journal of Pediatric Surgery 48(1):222-227. https://doi.org:10.1016/j.jpedsurg.2012.10.060 H.Schlange (1893) Uber die fistula colli congenital. ArchKlinChir 46:390–392. Sistrunk WE (1920) The Surgical Treatment of Cysts of the Thyroglossal Tract. Ann Surg 71(2):121-122 122. https://doi.org:10.1097/00000658-192002000-00002 Sistrunk WE (1928) Technique of removal of cysts and sinuses of the thyroglossal duct. Surg Gynecol Obstet 46:109–112. Auvenshine Rc Dds P, Pettit Nj Dmd MSD (2020) The hyoid bone: an overview. Cranio 38(1):6-14. https://doi.org:10.1080/08869634.2018.1487501 Ryu YJ, Kim DW, Jeon HW, Chang H, Sung MW, Hah JH (2015) Modified Sistrunk operation: New concept for management of thyroglossal duct cyst. Int J Pediatr Otorhinolaryngol 79(6):812-816. https://doi.org:10.1016/j.ijporl.2015.03.001 Kim MK, Pawel BR, Isaacson G (1999) Central neck dissection for the treatment of recurrent thyroglossal duct cysts in childhood. Otolaryngol Head Neck Surg 121(5):543-547. https://doi.org:10.1016/S0194-5998(99)70054-9 Horisawa M, Niinomi N, Nishimoto K, Matsunaga K, Ogura Y, Watanabe Y, et al. (1999) Clinical results of the shallow core-out procedure in thyroglossal duct cyst operation. J Pediatr Surg 34(11):1589-1592. https://doi.org:10.1016/s0022-3468(99)90622-x Boyd JD (1950) Development of the thyroid and parathyroid glands and the thymus. Annals of the Royal College of Surgeons of England 7(6):455-471. Soucy P, Penning J (1984) The clinical relevance of certain observations on the histology of the thyroglossal tract. Journal of Pediatric Surgery 19(5):506-509. Gumussoy M, Cukurova I (2021) Modified Sistrunk procedure in a pediatric population: Infected thyroglossal duct cysts as a risk factor for recurrence and review of the literature. Int J Pediatr Otorhinolaryngol 148:110837. https://doi.org:10.1016/j.ijporl.2021.110837 Arda MS, Ortega G, Layman IB, Khubchandani NA, Pichardo MS, Petrosyan M, et al. (2021) Sistrunk vs modified Sistrunk procedures: Does procedure type matter? J Pediatr Surg. https://doi.org:10.1016/j.jpedsurg.2021.03.044 Ein SH, Shandling B, Stephens CA, Mancer K (1984) The problem of recurrent thyroglossal duct remnants. Journal of Pediatric Surgery 19(4):437-439. Simon LM, Magit AE (2012) Impact of incision and drainage of infected thyroglossal duct cyst on recurrence after Sistrunk procedure. Arch Otolaryngol Head Neck Surg 138(1):20-24. https://doi.org:10.1001/archoto.2011.225 Kaselas C, Tsikopoulos G, Chortis C, Kaselas B (2005) Thyroglossal duct cyst's inflammation. When do we operate? Pediatr Surg Int 21(12):991-993. Türkyilmaz Z, Sönmez K, Karabulut R, Demirgoullari B, Sezer C, Basaklar AC, et al. (2004) Management of thyroglossal duct cysts in children. Pediatrics International : Official Journal of the Japan Pediatric Society 46(1):77-80. Rohof D, Honings J, Theunisse HJ, Schutte HW, van den Hoogen FJ, van den Broek GB, et al. (2015) Recurrences after thyroglossal duct cyst surgery: Results in 207 consecutive cases and review of the literature. Head Neck 37(12):1699-1704. https://doi.org:10.1002/hed.23817 Perkins JA, Inglis AF, Sie KCY, Manning SC (2006) Recurrent thyroglossal duct cysts: a 23-year experience and a new method for management. The Annals of Otology, Rhinology, and Laryngology 115(11):850-856. Pucher B, Jonczyk-Potoczna K, Kaluzna-Mlynarczyk A, Kurzawa P, Szydlowski J (2018) The Central Neck Dissection or the Modified Sistrunk Procedure in the Treatment of the Thyroglossal Duct Cysts in Children: Our Experience. Biomed Res Int 2018:8016957. https://doi.org:10.1155/2018/8016957 Tables Table 1 Patient characteristics, preoperative investigations and follow-up details Non-recurrence group (n=382) Recurrence group (n=9) Total (n=391) 𝓧 2 /Z p Basic Information Age, (y) 1.03 0.3099 a Median±SD 5.32±2.82 6.29±2.59 5.35±2.81 Range 0.76–15.02 3.35–11.6 0.76–15.02 Gender, n (%) 1.386 0.2391 b Male 239 (62.6%) 5 (55.6%) 244 (62.4%) Female 143 (37.4%) 4 (44.4%) 147 (37.6%) Medical History Disease course/(M) 0.05 0.8195 a Mean (SD) 14.35±17.37 13±26.79 14.32±17.60 Range 0.5–120 1–84 0.5–120 Chief complaint, n (%) 0.043 0.8348 b Neck masses 267 (69.9%) 6 (66.7%) 273 (69.8%) Neck infections 115 (30.1%) 3 (33.3%) 118 (30.2%) Surgical history 1.867 0.1719 Yes 348 (91.1%) 7 (77.8%) 355 (90.8%) No 34 (8.9%) 2 (22.2%) 36 (9.2%) Physical examination characteristics Palpable mass, n (%) 4.443 0.0351 b Yes 361 (94.5%) 7 (77.8%) 368 (94.1%) No 21 (5.5%) 2 (22.2%) 23 (5.9%) Good mobility, n (%) 0.243 0.6223 b Yes 225 (62.3%) 5 (71.4%) 230 (62.5%) No 136 (37.7%) 2 (28.6%) 138 (37.5%) Distinct boundary on palpation, n (%) 0.324 0.5690 b Yes 345 (95.6%) 7(100%) 352 (95.7%) No 16 (4.4%) 0 16 (4.3%) Incision and drainage history (%) 1.050 0.3056 b Yes 40 (10.5%) 0 40 (10.2%) No 342 (89.5%) 9 (100%) 351 (89.8%) Spontaneous rupture history (%) 0.067 0.7964 b Yes 54 (14.1%) 1 (11.1%) 55 (85.9%) No 328 (85.9%) 8 (88.9%) 336 (14.1%) Ultrasonographic characteristics Solitary lesion 0.263 0.8769 b Yes 315 (82.4%) 8 (88.9%) 323 (82.6%) No 67 (17.6%) 1 (9.1%) 68 (17.4%) Maximum diameter <2 cm, n (%) 10.883 0.0043 b Yes 276 (72.6%) 2 (22.2%) 278 (71.1%) No 104 (27.4%) 7 (77.8%) 112 (28.6%) Positional relation with hyoid bone, n (%) 2.277 0.6849 b Anterior hyoid bone 213 (55.8%) 4 (44.4%) 217 (55.5%) Suprahyoid 51 (13.4%) 2 (22.2%) 53 (13.6%) Subhyoid 104 (27.2%) 2 (22.2%) 106 (27.1%) Deep hyoid bone 14 (3.6%) 1 (11.1%) 15 (3.8%) Middle position of neck, n (%) 0.604 0.4483 b Yes 324 (84.8%) 9 (100%) 333 (85.2%) No 58 (15.2%) 0 (0) 58 (14.8%) Cystic echo, n (%) 0.000 0.9836 b Yes 196 (55.2%) 5 (55.6%) 201 (55.2%) No 159 (44.8%) 4 (44.4%) 163 (44.8%) Distinct boundary, n (%) 5.710 0.0169 b Yes 332 (90.7%) 6 (66.7%) 338 (90.1%) No 34 (9.3%) 3 (33.3%) 37 (9.9%) Surrounding tissues swelling, n (%) 0.033 0.8550 b No 331 (90.7%) 8 (88.9%) 339 (90.6%) Yes 34 (9.3%) 1 (11.1%) 35 (9.36%) Sinus tract and fistula, n (%) 0.086 0.1606 b No 264 (71.1%) 6 (66.7%) 270 (71.1%) Yes 107 (28.8%) 3 (33.3%) 110 (28.9%) Therapeutic strategies Postoperative use of antibiotics, n (%) 1.969 0.4634 b No 165 (43.1%) 6 (66.7%) 171 (43.7%) Yes 217 (56.8%) 3 (33.3%) 220 (56.3%) Postoperative indwelling of wound drainage tube, n (%) 0.071 0.7896 b No 379 (99.2%) 9 (100%) 388 (99.2%) Yes 3 (0.8%) 0 3 (0.8%) Postoperative indwelling of gastric tube n (%) 0.192 0.6609 b No 374 (97.9%) 9 (100%) 383 (98.0%) Yes 8 (2.1%) 0 8 (2.0%) Hospital stay /(D) -0.708 0.4791 a Mean (SD) 5.67±1.68 5.27±1.9 14.32±17.60 Range 1–13 2–9 0.5–120 Follow-up Follow-up time/(M) 0.7454 0.4560 a Mean (SD) 57.45±28.44 63.20±24.83 57.62±28.33 Range 3–120 31–94 3–120 Wound healing n (%) 0.267 0.8752 b Unremarkable 371 (97.1%) 9 (100%) 380 (97.2%) Local scarring 1 (0.3%) 0 1 (0.3%) Infection 10 (2.6%) 0 10 (2.5%) a. Wilcoxon rank-sum test; b. chi-square test Table 2. LogWorth sequence of recurrence-related risk factors in the multiple regression model Clinical characteristic LogWorth p lesion boundary （ultrasound） 3.516 0.0003 Maximum diameter (ultrasound, >2 cm or not) 1.929 0.0117 Surgical history 1.376 0.0420 Incision and drainage history 1.280 0.0524 Spontaneous rupture history 1.239 0.0576 Lesion boundary (on palpation) 1.217 0.0606 Disease course (0–6 m/6–12 m/>12 m) 0.829 0.1481 Chief complaint (mass/infection) 0.709 0.1956 Onset age(≥6 y or not) 0.607 0.2469 Sinus tract and fistula (ultrasound) 0.477 0.3337 Middle position of neck 0.450 0.3546 Gender 0.300 0.5008 Positional correlation with hyoid bone 0.257 0.5528 Surrounding tissues swelling or not 0.210 0.6163 Good mobility or not 0.164 0.6862 Cystic echo or not 0.084 0.8241 Number of lesions (>1 or not) 0.030 0.9322 Table 3. Poisson linear logarithm regression analysis. Factor B Standard error 95% Wald confidence interval Hypothesis testing Exp(B) 95% Wald confidence interval for Exp(B) Lower limit Upper limit Wald chi-square Degree of freedom Significance Lower limit Upper limit Intercept -5.781 0.9538 -7.650 -3.911 36.734 1 0.000 0.003 0.000 0.020 Maximum lesion diameter >2 cm (yes/no)* 1.888 0.8844 0.155 3.621 4.558 1 0.033 6.606 1.167 37.388 Surgical history (yes/no) 2.308 1.0153 0.318 4.298 5.167 1 0.023 10.054 1.374 73.549 Indistinct lesion boundary (yes/no) * 3.329 0.9231 1.520 5.138 13.009 1 0.000 27.918 4.573 170.445 Incision and drainage history (yes/no) -28.108 7.9562E+5 -1.5594E+6 1.559358E+6 0.000 1 1.000 6.208E-13 0.000 a Spontaneous rupture history (yes/no) -26.886 6.5818E+5 -1.2900E+6 1.2899E+6 0.000 1 1.000 2.106E-12 0.000 a Indistinct lesion boundary (yes/no) ** -29.534 - - - - - - 1.492E-13 0.000 0.000 * under ultrasound;** on palpation;- Since this parameter is superfluous, it is set to zero; a. It is set to system-missing value due to outflow. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYHACxgcfDGrk+NkbGx9+IFILs+GMimPGkj2Hm40liNTCJs1zhjlxw430NgEeYtQbnD/82IC3jY1xw82HbQwSDHZyug2EtNxIM3wg2SbDLHk7se1BAUOysdkBAlrMbvAwGxi2sbHx3U5sN5BgOJC4jaCW82fYJBLbmHkYbh5sk+AhSsuBHDaJA2eYJQRuMBKpxf5GmrFhQ8UxA8meRGAgGxDhF8n+ww8f/zGoqe9nP/7w4YcKOzmCWtCAAWnKR8EoGAWjYBTgAACskkXpGZ8FcQAAAABJRU5ErkJggg==","orcid":"","institution":"Beijing Children’s Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Shengcai","middleName":"","lastName":"Wang","suffix":""},{"id":215215713,"identity":"72130f94-c4f5-4e54-864d-6704208b682d","order_by":14,"name":"Xin Ni","email":"","orcid":"","institution":"Beijing Children’s Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Ni","suffix":""}],"badges":[],"createdAt":"2023-07-02 16:44:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3133237/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3133237/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":39586330,"identity":"9bafc844-dd4d-4f88-b509-d8dac7549b12","added_by":"auto","created_at":"2023-07-05 15:18:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":4207355,"visible":true,"origin":"","legend":"\u003cp\u003eMSis procedure.\u003c/p\u003e\n\u003cp\u003e(1a) Dissection of the cyst by resecting infrahyoid muscles (strap muscles) up to the hyoid bone.\u003c/p\u003e\n\u003cp\u003e(1b) Resection of the cartilaginous junction between the hyoid body and the greater horn by needle electrotom.\u003c/p\u003e\n\u003cp\u003e(1c) Dissection by upward wedge separation to the lingual foramen cecum.\u003c/p\u003e\n\u003cp\u003e(1d) Dissection ended at the level of lingual foramen cecum with cold knife resection of the fistula.\u003c/p\u003e\n\u003cp\u003e(1e) Suture and ligation of the fistula stump and figure-of-eight suturing in the deep area.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-3133237/v1/3af58d2ec95e19113473f041.png"},{"id":40191860,"identity":"c04bae22-63b1-4384-8363-cf8369f73385","added_by":"auto","created_at":"2023-07-18 13:14:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1380722,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3133237/v1/2e9ae45b-fef4-40b7-9b2e-e79dbd64ed6d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of the curative effect and risk factors for recurrence of modified Sistrunk procedure on thyroglossal duct cyst in children","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThyroglossal duct cyst (TGDC) is the most common congenital cervical malformation, accounting for approximately 70% of midline neck masses in children. It usually occurs in childhood within 10 years of age, albeit the age of onset is \u0026lt;\u0026thinsp;5 years, and no significant sex-related difference was observed[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The lesions of the thyroglossal duct originate from the incomplete degeneration of the channel formed by the decline in thyroid tissues during embryonic development, and the secretions of the residual ductal epithelium are accumulated to form cysts. A fistula is formed when a cyst has secondary infection or ruptures to the surface of the skin. Clinically, it manifests as an asymptomatic enlarged neck mass, which can be located anywhere from the submental area to the suprasternal notch and moves up and down with swallowing or an extended tongue. In case of infection, there are secretions at fistula orificium. Ultrasonic examination, computed tomography (CT), and magnetic resonance imaging (MRI) differentiate TGDC from other neck masses, such as dermoid cysts, lymph nodes, and ectopic thyroid[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]; among these methods, ultrasonography is most valuable in children. Notably, \u0026ldquo;fistula\u0026rdquo; formed by infection and rupture is a draining sinus tract. The embryological entity is the same as TGDC, but is often described separately due to varied clinical manifestations[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo date, surgical resection remains the most effective treatment option for TGDC. Except for lingual TGDC (the cyst is located at the root of the tongue, accounting for about 0.6\u0026ndash;3%[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]) that can be treated with suspension laryngoscopy, the modified Sistrunk (mSis) procedure remains the most effective option for children with neck TGDC[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The TGDC removal procedure has undergone development for more than a hundred years. In 1893, Schlange proposed for the first time to remove the middle hyoid bone while removing the cyst or fistula[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In 1920, Sistrunk proposed to remove the middle hyoid bone and the foramen cecum, thus formulating the classic Sistrunk procedure[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In 1928, Sistrunk modified this classic procedure, without emphasizing the removal of the foramen cecum of the tongue, but separating it to the mucosal layer of the mouth floor, retaining the sublingual root and maintaining a sterile environment for clean incisions in the neck[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]; thus, the mSis procedure was formulated.\u003c/p\u003e \u003cp\u003eIn the current study, we modified and optimized the operational details of the previously reported mSis procedure; then, the operative details and key points of practical experience in mSis were summarized and described. Also, the efficacy of the mSis procedure and prognosis were analyzed retrospectively, and the risk factors related to disease recurrence was assessed.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e1. Participants\u003c/p\u003e\n\u003cp\u003eThis was a case-control retrospective review of all patients who underwent mSis in Beijing Children\u0026rsquo;s Hospital, Beijing, China, and Baoding Children\u0026rsquo;s Hospital, Baoding, China from March 2012 to December 2021. The inclusion criteria: children aged 0-18 who were diagnosed TGDC and underwent mSis under general anesthesia. The exclusion criteria were as follows: 1) preoperatively diagnosed lingual TGDC; 2) children with preoperative clinical diagnosis of TGDC who did not undergo mSis because the correlation between the lesion and hyoid bone was not found during the procedure. A total of 391 cases met the inclusion criteria, including 361 from Beijing Children\u0026rsquo;s Hospital and 30 from Baoding Hospital of Beijing Children\u0026rsquo;s Hospital. The cohort comprised 244 males and 147 females, and the age range was 0.76\u0026ndash;15.02 (mean, 5.35\u0026plusmn;2.81) years.\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Medical Ethics Committee of Beijing Children\u0026rsquo;s Hospital, Capital Medical University [No. (2022)-E-228-R]. The patients and parents were involved in selecting the procedure, and signed the informed consent form for surgery.\u003c/p\u003e\n\u003cp\u003e2. Clinical data\u003c/p\u003e\n\u003cp\u003eThe data of medical and family history were collected, and all children underwent general physical and special examinations of the pharynx and neck (including thyroid and lymph nodes). Neck ultrasond was a nacessary preoperative examination to evaluate the location and nature of the lesion, the adjacent correlation with vital tissues and organs, as well as the hyoid bone, status of cervical lymph nodes, and confirm that the location and morphology of the thyroid gland. At the same time, fibrolaryngoscopy were used to exclude lingual TGDC.\u003c/p\u003e\n\u003cp\u003e3. Operative procedure\u003c/p\u003e\n\u003cp\u003eThe operation was performed under general anesthesia. All the included children underwent standard mSis procedure carried out by the team\u0026rsquo;s deputy senior or senior chief physician. The key steps of the operation were as follows:\u003c/p\u003e\n\u003col style=\"list-style-type: lower-roman;\"\u003e\n \u003cli\u003eExposure and anatomy of the cyst: The skin, subcutaneous tissues, and platysmas were cut, and the flap was flipped. The suprahyoid and infrahyoid muscles (strap muscles) (Fig. 1a) were cut transversely above and below the cyst and the middle part of the connected hyoid bone. The fully exposed cyst was then dissected using a tungsten alloy needle electrotom to ensure accurate surgical manipulation while avoiding rupture.\u003c/li\u003e\n \u003cli\u003eCutting the hyoid bone: Allis forceps were used to lift the middle part of the hyoid bone. After releasing the attachment of the suprahyoid muscles and infrahyoid muscles, the cartilaginous junction between the hyoid body and the greater horn was resected by needle electrotom; the bilateral hyoid bone stumps simultaneously underwent electrocoagulation (Fig. 1b). The remnants of the hyoid body were removed carefully in relapsed patients.\u003c/li\u003e\n \u003cli\u003eCore out to the foramen cecum: The cyst and the middle hyoid bone were lifted, and dissection continued to the upward wedge separation to lingual foramen cecum and ended at the level of mouth floor mucosa (usually the lingual muscle at the lingual foramen cecum is ring-shaped) (Fig. 1c); entering the pharyngeal cavity was avoided to prevent pharyngeal fistula. In the tongue root mucosa, the fistula was dissected with cold knife to preserve the integrity of the mouth floor mucosa (Fig. 1d). The fistula mucosal epithelium in the dissected tissues was confirmed by naked eyes. The fistula stump was sutured and ligated, and a figure-of-eight suturing was made in the deep area wherein a small potential segment of fistula was connected with the lingual foramen cecum (Fig. 1e). The figure-of-eight suturing was not too high or too deep to suture the epiglottis, and the operated cavity was closed layer-by-layer after hemostasis.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e4. Follow-up\u003c/p\u003e\n\u003cp\u003eThe resected specimens of all patients were routinely submitted for pathological examination. All children completed the first re-examination 7\u0026ndash;10 days after the procedure and were followed up via outpatient revisits at 1, 3, and 6 months and 1 year subsequently. The follow-up included physical examination and ultrasonography within the first postoperative year, followed by annual telephone follow-up. The possible complications, such as pain, scar, infection, mass recurrence, dysphagia, pharyngeal fistula, tongue deviation, and neck movement limitation were inquired about and focused upon during the follow-up, which ended on March 1, 2023, i.e., 15\u0026ndash;156 (mean, 69.62\u0026plusmn;28.33) months. If cervical infection or mass recurred during the follow-up, ultrasonography was performed at the earliest.\u003c/p\u003e\n\u003cp\u003e5. Statistical methods\u003c/p\u003e\n\u003cp\u003eThe statistical data were compared between the two groups using SPSS for Windows v12.0 (SPSS, Inc., Chicago, IL, USA), and a p-value \u0026lt;0.05 was considered statistically significant. For the between-group comparison of quantitative data, the independent-sample t-test was conducted in case of normal distribution and homogeneity of variance, and the Wilcoxon rank-sum test was applied in case of non-normal distribution. A chi-square test and the Wilcoxon rank-sum test was used for the between-group comparison of binary and ranked data, respectively. In multivariate analysis, Poisson regression was used instead of multivariate logistic regression due to a large difference in the number of cases between the recurrence and the non-recurrence groups (382/9).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e1. Demographic information and clinical characteristics\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA total of 391 children were included in the present study with disease course of 0.5\u0026ndash;120 (average, 14.32\u0026plusmn;17.60) months. The clinical information of 391 children with TGDC is summarized in Table 1. The mean age of the TGDC cohort was 5.35\u0026plusmn;2.81 years, included 244 males and 147 females, and comprised 273 (69.8%) children who sought medical treatment due to neck masses and 118 (30.2%) with neck infections. Moreover, 36/391 (9.2%) had undergone surgery previously at other hospitals with the initial diagnosis of neck cyst (22), thyroglossal duct cyst (12) and branchial fistula (2), and the 36 cases underwent neck cyst and fistula resection surgery before, with only 6 cases underwent partial hyoid bone resection at the same.\u003c/p\u003e\n\u003cp\u003e2. Safety and effectiveness\u003c/p\u003e\n\u003cp\u003eDuring the follow-up, 10 children presented local wound infection but no recurrence and only 1 child was not satisfied with incision scar, but none had other complications, such as bleeding, unplanned reoperation, unplanned intubation, pneumonia, nerve injury, dysphagia, pharyngeal fistula, tongue deviation, and limited neck movement. Regarding effectiveness, 9/391 children experienced recurrence, with an overall recurrence rate of 2.30%. Among those with recurrence, 7 had cervical masses, and 2 had redness, swelling, or pus in the neck wound. The recurrence time ranged from 0.5\u0026ndash;34 (median=5) months after the procedure and the recurrence time of 8 children was less than 7 months.\u003c/p\u003e\n\u003cp\u003e3. Risk factors of recurrence\u003c/p\u003e\n\u003cp\u003eBased on the presence or absence of recurrence, all 391 children were assigned to the non-recurrence and recurrence groups. The basic information, disease characteristics, treatment, and follow-up information of the two groups are compared in Table 1. The results indicated statistically significant differences between the groups in terms of palpable mass in the neck, the maximum diameter of the lesion, and lesion boundary under ultrasound. However, multivariate analysis was needed to eliminate the mutual interference among the factors.\u003c/p\u003e\n\u003cp\u003eThe LogWorth of each clinical characteristic in the multiple regression model was calculated, and each factor arranged in an ascending order based on the p-value. Based on the clinical value and statistical significance, six variables with LogWorth \u0026gt;1 and p-value \u0026lt;0.1 were included in multivariate analysis (Table 2).\u003c/p\u003e\n\u003cp\u003eDue to the low incidence of recurrence and the large difference in sample size between the recurrence and non-recurrence groups (9/382), Poisson linear logarithm regression was used to evaluate the related factors of recurrence. The frequency of recurrence, consistent with Poisson distribution (Kolmogorov-Sminov Z value =0.005 and p\u003cem\u003e-\u003c/em\u003evalue =1.000 in Poisson distribution test), was used as the dependent variable, and the main effect included the top six independent variables in Table 2. The deviation value/degree of freedom in the goodness-of-fit of the model was 0.100, which met the requirement of equal discreteness; the Omnibus value of the global test was significant at 0.002. The statistically significant parameters are shown in Table 3 (independent variables with p\u0026lt;0.05). The results suggested that the p-values of the three factors of clearness of lesion boundary, surgical history, and lesion diameter in the model were \u0026lt;0.05, indicating statistical significance and deeming them independent risk factors for recurrence. Correspondingly, the relative risk (RR) values for the above three risk factors, such as Exp (B), were 27.918, 10.054, and 6.606, respectively, suggesting that TGDC children with indistinct lesion boundary under ultrasound, surgical history, and the maximum lesion diameter \u0026gt;2 cm were 26.918, 9.054, and 5.606 times more likely to have recurrence compared to those without the above characteristics, respectively.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e1. Operation procedure\u003c/p\u003e\n\u003cp\u003eBased on our practical experience, the mSis procedure has been optimized in the following details: the resection at the cartilaginous joint of hyoid bone, core out to the foramen cecum, and the resection and ligation techniques of the fistula near the foramen cecum. These detailed modifications realized the complete resection of the lesions while reducing injuries, further lowering the recurrence rate.\u003c/p\u003e\n\u003cp\u003e1.1 Operation procedures of hyoid bone. In the traditional modified Sistrunk surgery, the central body or middle third of the hyoid bone was transversely cut with the bone cutting forceps on both sides of the hyoid body. The operation procedure adapted in the present study used the needle electrotom to divide the cartilaginous junction between the hyoid body and the greater horn by combining the advantages of the anatomical characteristics in childhood. An overview of the hyoid bone discovered that until middle age, the connection between the body and the greater cornu is fibrous[9]. Therefore, for pediatric TGDC, the needle electrotom can easily accomplish the division of the cartilaginous junction between the body and the greater horn without unnecessary bleeding. A similar conclusion was reported by Ryu et al. after studying 26 pediatric patients[10].\u003c/p\u003e\n\u003cp\u003e1.2 The tracking and anatomy of foramen cecum. It should be emphasized the importance of \u0026nbsp;maintaining the en bloc principle without trying to identify a sinus tract in the region superior to the hyoid bone[11], and the cuff column of about 1-cm tissue volume was completely separated to the mucosal of lingual foramen cecum level, encompassing mylohyoid muscles and genioglossus. According to Sistrunk, the cuff diameter of tissues around the lingual duct separated along the suprahyoid bone is about 3 mm[8]. However, Horisawa et al. found extensive branches at suprahyoid and infrahyoid areas in the three-dimensional reconstruction of the thyroglossal duct[12]. In 1950, Boyd proposed that the rupture of the thyroglossal duct shortens and thickens the proximal portion, and its epithelium resembles that of the tongue and frequently re-develops a lumen from which an extensive system of branches is grown[13]. Soucy and Penning reviewed 44 TGDC pathological sections and demonstrated that the thyroglossal duct delivers many dendritic branches to the surrounding tissues[14], such that the resection range covered these hidden branch fistulae. Since the separation is deep to the mucosal layer of the foramen cecum, the cold knife should be used for dissection to avoid the possible risk of pharyngeal fistula caused by electrotom resection, affecting healing and facilitating visual observation to confirm the fistula mucosal epithelium in the resected tissues. This procedure does not enter the pharyngeal cavity, avoiding the purse string suture and adopting figure-of-eight suture to consolidate the stumps. Since fully bending backward position would cause glossocoma and tracheal intubation would be close to epiglottis and the root of the tongue, the suture should not be extremely deep.\u003c/p\u003e\n\u003cp\u003e2. Recurrence and the risk factor\u003c/p\u003e\n\u003cp\u003eThe sample size of previous case-control studies on the application of mSis in TGDC ranged from 24\u0026ndash;251, and the recurrence rate was 1.6\u0026ndash;16.1%[15, 16]. The present study has the largest sample size involving retrospective data of mSis in children, and the recurrence rate (2.30%, during 15\u0026ndash;156-months follow-up) was lower than the average reported by other studies. Statistical analysis revealed that the distinct lesion boundary, surgical history, and lesion diameter were independent risk factors for disease recurrence.\u003c/p\u003e\n\u003cp\u003e2.1Leision boundary. In this study, the indistinct lesion boundary suggested that infection can lead to local inflammatory or cicatricial adhesions. Moreover, the duration of surgery was 2 weeks after the infection was controlled. However, the above findings indicated that although the skin surface indicated controlled infection, the internal peripheral lesions might still be in the inflammatory recovery stage of the infection. When TGDC is in the infection stage, the tissue is edematous and congested, and the fistula wall and small branches have poor elasticity and toughness and are easy to rupture when separated. Although several studies suggested an association between infection and recurrence[17-19], some reports do not support this association[20, 21]. The present findings demonstrated that the preoperative occult infection stage might affect the complete resection of the small branches and fistulas during the procedure, leading to recurrence.\u003c/p\u003e\n\u003cp\u003e3.2 Secondary surgery. For patients with surgical history of neck masses, local inflammatory or cicatricial adhesions, unclear anatomical level, and blind operation poses significant challenges for a complete resection of the cysts and fistulas in secondary surgery, leading to residual and recurrent fistulas and the formation of small branches. Kim found that even if experienced doctors used the classic Sistrunk procedure to resect TGDC, the mean recurrence rate was \u0026gt;4%, and re-surgery failed in 33% of recurrent patients[11]. In the present study, the failure rate of re-surgery in the recurrent patients was 5.6% (2/36), further suggesting that in children undergoing non-standard surgeries, such as simple cyst resection and non-dissection of hyoid bone, intraoperative procedures should be detailed and thorough. Perkins et al. demonstrated that if the hyoid bone was not dissected in the first surgery, re-surgery after recurrence would increase the risk of second recurrence[22]. Some studies reported a successful experience of the central neck dissection in the treatment of recurrent TGDC, expanding the resection range of Sistrunk procedure to include the anterior tracheal soft tissues to realize the en bloc resection; the width of the resected tissue volume of the strap muscles and hyoid bone was 3-4 cm and that of the foramen cecum reached 2-3 cm[23]. Moreover, no recurrence or serious complication was observed after the central neck dissection, but risks, such as damage to the internal carotid artery, vagus nerve, and entry into the pharyngeal cavity could not be ignored. These findings provided a reference to improve the efficacy in the treatment of children with recurrent and refractory TGDC after repeated surgeries.\u003c/p\u003e\n\u003cp\u003e3.3 Leision size. In addition, some researchers proposed a correlation between the cyst size and recurrence[21]. Clinically, the volume of the cyst does not change or changes slowly. If the cyst is infected, the volume increases in a short time but is reduced rapidly when the infection is controlled. The present study found that lesion diameter (\u0026gt;2 cm) is a major risk factor for recurrence. Thus, it is speculated that large cysts are prone to rupture during surgery and leakage into the surrounding tissues, resulting in indistinct boundaries. On the other hand, some children may still be in the recovery stage post-infection.\u003c/p\u003e\n\u003cp\u003e4. Limitations.\u003c/p\u003e\n\u003cp\u003eNevertheless, the present study has several limitations. First, due to the limited sample size, combined with the lower recurrence rate, the sample size of the recurrence and the non-recurrence groups was significantly different, causing bias in the results. Second, the follow-up time was limited. Although the minimum follow-up time of this study (15 months) was significantly longer than the recurrence time (\u0026lt;7 months) of most recurrent children (8/9), there may be potential relapses that may not have been found. Third, the duration for the case included in the present study was prolonged, while the experience of the mSis procedure was accumulated gradually. During continuous unification of surgical details, the surgery-related habits of different surgeons also have a potential impact on the findings. Fourth, for children with recurrence after undergoing mSis procedure, constant attention and investigation are warranted for developing therapeutic regimens, including re-resection, ultrasound-guided local injection of hardening agents, and endoscopic resection of masses at the tongue root (for those with secondary lingual TGDC), to accumulate experience.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe mSis is currently the a widely used procedure in the clinical treatment of children with TGDC. Combining the anatomical characteristics in childhood, the present study made a detailed optimization based on the previous mSis procedure and integrated the complete resection with less injury. Thus, the procedure was safe and effective with fewer complication and a low recurrence rate. In addition, the indistinct lesion boundaries, surgical history, and large diameter of lesion are independent risk factors for TGDC recurrence. For children with such clinical characteristics, the accurate operative skill of mSis procedures should be detailed and thorough in to reduce the recurrence rate.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRadkowski D, Arnold J, Healy GB, McGill T, Treves ST, Paltiel H, et al. (1991) Thyroglossal duct remnants. Preoperative evaluation and management. Arch Otolaryngol Head Neck Surg 117(12):1378-1381. https://doi.org:10.1001/archotol.1991.01870240070011\u003c/li\u003e\n\u003cli\u003eZander DA, Smoker WR (2014) Imaging of ectopic thyroid tissue and thyroglossal duct cysts. Radiographics 34(1):37-50. https://doi.org:10.1148/rg.341135055\u003c/li\u003e\n\u003cli\u003ede Tristan J, Zenk J, Kunzel J, Psychogios G, Iro H (2015) Thyroglossal duct cysts: 20 years\u0026apos; experience (1992-2011). Eur Arch Otorhinolaryngol 272(9):2513-2519. https://doi.org:10.1007/s00405-014-3229-6\u003c/li\u003e\n\u003cli\u003eSameer KSM, Mohanty S, Correa MMA, Das K (2012) Lingual thyroglossal duct cysts--a review. International Journal of Pediatric Otorhinolaryngology 76(2):165-168. https://doi.org:10.1016/j.ijporl.2011.11.025\u003c/li\u003e\n\u003cli\u003eGalluzzi F, Pignataro L, Gaini RM, Hartley B, Garavello W (2013) Risk of recurrence in children operated for thyroglossal duct cysts: A systematic review. Journal of Pediatric Surgery 48(1):222-227. https://doi.org:10.1016/j.jpedsurg.2012.10.060\u003c/li\u003e\n\u003cli\u003eH.Schlange (1893) Uber die fistula colli congenital. ArchKlinChir 46:390\u0026ndash;392. \u003c/li\u003e\n\u003cli\u003eSistrunk WE (1920) The Surgical Treatment of Cysts of the Thyroglossal Tract. Ann Surg 71(2):121-122 122. https://doi.org:10.1097/00000658-192002000-00002\u003c/li\u003e\n\u003cli\u003eSistrunk WE (1928) Technique of removal of cysts and sinuses of the thyroglossal duct. Surg Gynecol Obstet 46:109\u0026ndash;112. \u003c/li\u003e\n\u003cli\u003eAuvenshine Rc Dds P, Pettit Nj Dmd MSD (2020) The hyoid bone: an overview. Cranio 38(1):6-14. https://doi.org:10.1080/08869634.2018.1487501\u003c/li\u003e\n\u003cli\u003eRyu YJ, Kim DW, Jeon HW, Chang H, Sung MW, Hah JH (2015) Modified Sistrunk operation: New concept for management of thyroglossal duct cyst. Int J Pediatr Otorhinolaryngol 79(6):812-816. https://doi.org:10.1016/j.ijporl.2015.03.001\u003c/li\u003e\n\u003cli\u003eKim MK, Pawel BR, Isaacson G (1999) Central neck dissection for the treatment of recurrent thyroglossal duct cysts in childhood. Otolaryngol Head Neck Surg 121(5):543-547. https://doi.org:10.1016/S0194-5998(99)70054-9\u003c/li\u003e\n\u003cli\u003eHorisawa M, Niinomi N, Nishimoto K, Matsunaga K, Ogura Y, Watanabe Y, et al. (1999) Clinical results of the shallow core-out procedure in thyroglossal duct cyst operation. J Pediatr Surg 34(11):1589-1592. https://doi.org:10.1016/s0022-3468(99)90622-x\u003c/li\u003e\n\u003cli\u003eBoyd JD (1950) Development of the thyroid and parathyroid glands and the thymus. Annals of the Royal College of Surgeons of England 7(6):455-471. \u003c/li\u003e\n\u003cli\u003eSoucy P, Penning J (1984) The clinical relevance of certain observations on the histology of the thyroglossal tract. Journal of Pediatric Surgery 19(5):506-509. \u003c/li\u003e\n\u003cli\u003eGumussoy M, Cukurova I (2021) Modified Sistrunk procedure in a pediatric population: Infected thyroglossal duct cysts as a risk factor for recurrence and review of the literature. Int J Pediatr Otorhinolaryngol 148:110837. https://doi.org:10.1016/j.ijporl.2021.110837\u003c/li\u003e\n\u003cli\u003eArda MS, Ortega G, Layman IB, Khubchandani NA, Pichardo MS, Petrosyan M, et al. (2021) Sistrunk vs modified Sistrunk procedures: Does procedure type matter? J Pediatr Surg. https://doi.org:10.1016/j.jpedsurg.2021.03.044\u003c/li\u003e\n\u003cli\u003eEin SH, Shandling B, Stephens CA, Mancer K (1984) The problem of recurrent thyroglossal duct remnants. Journal of Pediatric Surgery 19(4):437-439. \u003c/li\u003e\n\u003cli\u003eSimon LM, Magit AE (2012) Impact of incision and drainage of infected thyroglossal duct cyst on recurrence after Sistrunk procedure. Arch Otolaryngol Head Neck Surg 138(1):20-24. https://doi.org:10.1001/archoto.2011.225\u003c/li\u003e\n\u003cli\u003eKaselas C, Tsikopoulos G, Chortis C, Kaselas B (2005) Thyroglossal duct cyst\u0026apos;s inflammation. When do we operate? Pediatr Surg Int 21(12):991-993. \u003c/li\u003e\n\u003cli\u003eT\u0026uuml;rkyilmaz Z, S\u0026ouml;nmez K, Karabulut R, Demirgoullari B, Sezer C, Basaklar AC, et al. (2004) Management of thyroglossal duct cysts in children. Pediatrics International : Official Journal of the Japan Pediatric Society 46(1):77-80. \u003c/li\u003e\n\u003cli\u003eRohof D, Honings J, Theunisse HJ, Schutte HW, van den Hoogen FJ, van den Broek GB, et al. (2015) Recurrences after thyroglossal duct cyst surgery: Results in 207 consecutive cases and review of the literature. Head Neck 37(12):1699-1704. https://doi.org:10.1002/hed.23817\u003c/li\u003e\n\u003cli\u003ePerkins JA, Inglis AF, Sie KCY, Manning SC (2006) Recurrent thyroglossal duct cysts: a 23-year experience and a new method for management. The Annals of Otology, Rhinology, and Laryngology 115(11):850-856. \u003c/li\u003e\n\u003cli\u003ePucher B, Jonczyk-Potoczna K, Kaluzna-Mlynarczyk A, Kurzawa P, Szydlowski J (2018) The Central Neck Dissection or the Modified Sistrunk Procedure in the Treatment of the Thyroglossal Duct Cysts in Children: Our Experience. Biomed Res Int 2018:8016957. https://doi.org:10.1155/2018/8016957\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1 \u0026nbsp; \u0026nbsp; Patient characteristics, preoperative investigations and follow-up details\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003eNon-recurrence group (n=382)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.49484536082474%\"\u003e\n \u003cp\u003eRecurrence group (n=9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\"\u003e\n \u003cp\u003eTotal (n=391)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.309278350515465%\"\u003e\n \u003cp\u003e𝓧\u003csup\u003e2\u003c/sup\u003e/Z\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.306122448979592%\" rowspan=\"6\"\u003e\n \u003cp\u003eBasic Information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"63.265306122448976%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eAge, (y)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.204081632653061%\" valign=\"top\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\" valign=\"top\"\u003e\n \u003cp\u003e0.3099\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eMedian\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e5.32\u0026plusmn;2.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e6.29\u0026plusmn;2.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e5.35\u0026plusmn;2.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e0.76\u0026ndash;15.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e3.35\u0026ndash;11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e0.76\u0026ndash;15.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eGender, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e1.386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.2391\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e239 (62.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e5 (55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e244 (62.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e143 (37.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e4 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e147 (37.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.306122448979592%\" rowspan=\"9\"\u003e\n \u003cp\u003eMedical History\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"63.265306122448976%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDisease course/(M)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.204081632653061%\" valign=\"top\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\" valign=\"top\"\u003e\n \u003cp\u003e0.8195\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e14.35\u0026plusmn;17.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e13\u0026plusmn;26.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e14.32\u0026plusmn;17.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e0.5\u0026ndash;120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e1\u0026ndash;84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e0.5\u0026ndash;120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eChief complaint, n (%) \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.8348\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNeck masses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e267 (69.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e6 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e273 (69.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNeck infections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e115 (30.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e3 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e118 (30.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eSurgical history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e1.867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.1719\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e348 (91.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e7 (77.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e355 (90.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e34 (8.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e2 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e36 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.306122448979592%\" rowspan=\"15\"\u003e\n \u003cp\u003ePhysical examination characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"63.265306122448976%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003ePalpable mass, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.204081632653061%\" valign=\"top\"\u003e\n \u003cp\u003e4.443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\" valign=\"top\"\u003e\n \u003cp\u003e0.0351\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e361 (94.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e7 (77.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e368 (94.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e21 (5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e2 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e23 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eGood mobility, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.6223\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e225 (62.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e5 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e230 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e136 (37.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e2 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e138 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDistinct boundary on palpation, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.5690\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e345 (95.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e7(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e352 (95.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e16 (4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e16 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eIncision and drainage history\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e1.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.3056\u003csup\u003e\u0026nbsp;b\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e40 (10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e40 (10.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e342 (89.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e9 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e351 (89.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eSpontaneous rupture history (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.7964\u003csup\u003e\u0026nbsp;b\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e54 (14.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e1 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e55 (85.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e328 (85.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e8 (88.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e336 (14.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.306122448979592%\" rowspan=\"26\"\u003e\n \u003cp\u003eUltrasonographic characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"63.265306122448976%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eSolitary lesion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.204081632653061%\" valign=\"top\"\u003e\n \u003cp\u003e0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\" valign=\"top\"\u003e\n \u003cp\u003e0.8769\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e315 (82.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e8 (88.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e323 (82.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e67 (17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e1 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e68 (17.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eMaximum diameter \u0026lt;2 cm, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e10.883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.0043\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"bottom\"\u003e\n \u003cp\u003e276 (72.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e2 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e278 (71.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e104 (27.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e7 (77.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e112 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003ePositional relation with hyoid bone, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e2.277\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.6849\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eAnterior hyoid bone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"bottom\"\u003e\n \u003cp\u003e213 (55.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e4 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e217 (55.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eSuprahyoid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"bottom\"\u003e\n \u003cp\u003e51 (13.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e2 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e53 (13.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eSubhyoid\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"bottom\"\u003e\n \u003cp\u003e104 (27.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e2 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e106 (27.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eDeep hyoid bone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"bottom\"\u003e\n \u003cp\u003e14 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e1 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e15 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eMiddle position of neck, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e0.604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.4483\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"bottom\"\u003e\n \u003cp\u003e324 (84.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e9 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e333 (85.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e58 (15.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e58 (14.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eCystic echo, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.9836\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e196 (55.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e5 (55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e201 (55.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e159 (44.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e4 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e163 (44.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eDistinct boundary, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e5.710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.0169\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"bottom\"\u003e\n \u003cp\u003e332 (90.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e6 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e338 (90.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"bottom\"\u003e\n \u003cp\u003e34 (9.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e3 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e37 (9.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eSurrounding tissues swelling, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.8550\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e331 (90.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e8 (88.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e339 (90.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e34 (9.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e1 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e35 (9.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eSinus tract and fistula, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.1606\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e264 (71.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e6 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e270 (71.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e107 (28.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e3 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e110 (28.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.306122448979592%\" rowspan=\"12\"\u003e\n \u003cp\u003eTherapeutic strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"63.265306122448976%\" colspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003ePostoperative use of antibiotics, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.204081632653061%\" valign=\"top\"\u003e\n \u003cp\u003e1.969\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\" valign=\"top\"\u003e\n \u003cp\u003e0.4634\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e165 (43.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e6 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e171 (43.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e217 (56.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e3 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e220 (56.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative indwelling of wound drainage tube, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.7896\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e379 (99.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e9 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e388 (99.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e3 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e3 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003ePostoperative indwelling of gastric tube n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.6609\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e374 (97.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e9 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e383 (98.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e8 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e8 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eHospital stay /(D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e-0.708\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.4791\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e5.67\u0026plusmn;1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e5.27\u0026plusmn;1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e14.32\u0026plusmn;17.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e1\u0026ndash;13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e2\u0026ndash;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e0.5\u0026ndash;120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.306122448979592%\" rowspan=\"7\"\u003e\n \u003cp\u003eFollow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"63.265306122448976%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eFollow-up time/(M)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.204081632653061%\" valign=\"top\"\u003e\n \u003cp\u003e0.7454\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.224489795918368%\" valign=\"top\"\u003e\n \u003cp\u003e0.4560\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e57.45\u0026plusmn;28.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e63.20\u0026plusmn;24.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e57.62\u0026plusmn;28.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e3\u0026ndash;120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\" valign=\"top\"\u003e\n \u003cp\u003e31\u0026ndash;94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003e3\u0026ndash;120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.6987951807229%\" colspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003eWound healing n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\" valign=\"top\"\u003e\n \u003cp\u003e0.267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.25301204819277%\" valign=\"top\"\u003e\n \u003cp\u003e0.8752\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eUnremarkable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e371 (97.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\"\u003e\n \u003cp\u003e9 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e380 (97.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eLocal scarring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.29268292682927%\" valign=\"top\"\u003e\n \u003cp\u003eInfection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e10 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.51219512195122%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.29268292682927%\"\u003e\n \u003cp\u003e10 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.195121951219512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\" valign=\"bottom\"\u003e\n \u003cp\u003ea. Wilcoxon rank-sum test; b. chi-square test\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2. LogWorth sequence of recurrence-related risk factors in the multiple regression model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical characteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLogWorth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003elesion boundary\u0026nbsp;（ultrasound）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e3.516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.0003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003eMaximum diameter (ultrasound, \u0026gt;2 cm or not)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e1.929\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.0117\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003eSurgical history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e1.376\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.0420\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003eIncision and drainage history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e1.280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.0524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003eSpontaneous rupture history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e1.239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.0576\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003eLesion boundary (on palpation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e1.217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.0606\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003eDisease course (0\u0026ndash;6 m/6\u0026ndash;12 m/\u0026gt;12 m)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.1481\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003eChief complaint (mass/infection)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.709\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.1956\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003eOnset age(\u0026ge;6 y or not)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.607\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.2469\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003eSinus tract and fistula (ultrasound)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.477\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.3337\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003eMiddle position of neck\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.450\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.3546\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.5008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003ePositional correlation with hyoid bone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.5528\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003eSurrounding tissues swelling or not\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.6163\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003eGood mobility or not\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.6862\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003eCystic echo or not\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.8241\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.0933660933661%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of lesions (\u0026gt;1 or not)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.953316953316953%\" valign=\"top\"\u003e\n \u003cp\u003e0.9322\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"101%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"11\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3. Poisson linear logarithm regression analysis.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" rowspan=\"2\"\u003e\n \u003cp\u003eFactor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.208333333333333%\" rowspan=\"2\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" rowspan=\"2\"\u003e\n \u003cp\u003eStandard error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.708333333333332%\" colspan=\"2\"\u003e\n \u003cp\u003e95% Wald confidence interval\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.833333333333332%\" colspan=\"3\"\u003e\n \u003cp\u003eHypothesis testing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" rowspan=\"2\"\u003e\n \u003cp\u003eExp(B)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" colspan=\"2\"\u003e\n \u003cp\u003e95% Wald confidence interval for Exp(B)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eLower limit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003eUpper limit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\"\u003e\n \u003cp\u003eWald\u0026nbsp;chi-square\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003eDegree of freedom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\"\u003e\n \u003cp\u003eSignificance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003eLower limit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.244897959183673%\"\u003e\n \u003cp\u003eUpper limit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.595744680851062%\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e-5.781\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.51063829787234%\"\u003e\n \u003cp\u003e0.9538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.51063829787234%\"\u003e\n \u003cp\u003e-7.650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.574468085106384%\"\u003e\n \u003cp\u003e-3.911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e36.734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.595744680851062%\"\u003e\n \u003cp\u003eMaximum lesion diameter \u0026gt;2 cm (yes/no)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e1.888\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.51063829787234%\"\u003e\n \u003cp\u003e0.8844\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.51063829787234%\"\u003e\n \u003cp\u003e0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.574468085106384%\"\u003e\n \u003cp\u003e3.621\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e4.558\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e6.606\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e1.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e37.388\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.595744680851062%\"\u003e\n \u003cp\u003eSurgical history\u0026nbsp;(yes/no)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e2.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.51063829787234%\"\u003e\n \u003cp\u003e1.0153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.51063829787234%\"\u003e\n \u003cp\u003e0.318\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.574468085106384%\"\u003e\n \u003cp\u003e4.298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e5.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e10.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e1.374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e73.549\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.595744680851062%\"\u003e\n \u003cp\u003eIndistinct lesion boundary \u0026nbsp;(yes/no) *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e3.329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.51063829787234%\"\u003e\n \u003cp\u003e0.9231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.51063829787234%\"\u003e\n \u003cp\u003e1.520\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.574468085106384%\"\u003e\n \u003cp\u003e5.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e13.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e27.918\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e4.573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e170.445\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.595744680851062%\"\u003e\n \u003cp\u003eIncision and drainage \u0026nbsp;history (yes/no)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e-28.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.51063829787234%\"\u003e\n \u003cp\u003e7.9562E+5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.51063829787234%\"\u003e\n \u003cp\u003e-1.5594E+6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.574468085106384%\"\u003e\n \u003cp\u003e1.559358E+6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e6.208E-13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003ea\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.595744680851062%\"\u003e\n \u003cp\u003eSpontaneous rupture history (yes/no)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e-26.886\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.51063829787234%\"\u003e\n \u003cp\u003e6.5818E+5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.51063829787234%\"\u003e\n \u003cp\u003e-1.2900E+6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.574468085106384%\"\u003e\n \u003cp\u003e1.2899E+6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e2.106E-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003ea\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.595744680851062%\"\u003e\n \u003cp\u003eIndistinct\u0026nbsp;lesion boundary (yes/no)\u0026nbsp;**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.319148936170213%\"\u003e\n \u003cp\u003e-29.534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.51063829787234%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.51063829787234%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.574468085106384%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e1.492E-13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.446808510638298%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.382978723404255%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"11\"\u003e\n \u003cp\u003e* under ultrasound;** on palpation;- Since this parameter is superfluous, it is set to zero; a. It is set to system-missing value due to outflow.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"thyroglossal duct cyst, congenital neck mass, pediatric, Sistrunk procedure","lastPublishedDoi":"10.21203/rs.3.rs-3133237/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3133237/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study aimed to retrospectively summarize the optimization experience of the modified Sistrunk (mSis) procedure, analyze the curative efficacy of this procedure in the treatment of children with thyroglossal duct cyst (TGDC), and investigate the related risk factors for recurrence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA retrospective analysis was conducted on children undergoing mSis procedure from March 2012–December 2021. Based on our practical experience, the mSis procedure has been optimized in the following details: the resection at the cartilaginous joint of hyoid bone, core out to the foramen cecum, and the resection and ligation techniques of the fistula near the foramen cecum. Medical history, physical examination characteristics, ultrasound characteristics, and prognosis were evaluated by regression analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 391 children with TGDC, the recurrence rate was 2.30% and the recurrence time ranged from 0.5–34 (average, 7.2) months after the procedure. During the follow-up, 10 children had local wound infection but no recurrence and none had other complications. In the Poisson regression model, the \u003cem\u003ep\u003c/em\u003e-values of the three factors of clearness of lesion boundary, surgical history, and lesion diameter were \u0026lt; 0.05 and the relative risk (RR) values corresponding to the above three risk factors, such as Exp (B), were 27.918, 10.054, and 6.606, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study made optimizations based on the previous mSis procedure and integrated the complete resection and less injury. Thus, the procedure was safe and effective with fewer complications and a low recurrence rate. In addition, the indistinct lesion boundary, surgical history, and large lesion diameter were independent risk factors for disease recurrence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLevel of Evidence:\u003c/strong\u003e IV\u003c/p\u003e","manuscriptTitle":"Analysis of the curative effect and risk factors for recurrence of modified Sistrunk procedure on thyroglossal duct cyst in children","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-07-05 15:18:15","doi":"10.21203/rs.3.rs-3133237/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0766c330-ab9e-44a1-b1d6-4d9ede61d86c","owner":[],"postedDate":"July 5th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-07-18T13:14:29+00:00","versionOfRecord":[],"versionCreatedAt":"2023-07-05 15:18:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3133237","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3133237","identity":"rs-3133237","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}