A ganglion cyst is a small, fluid-filled sac that forms over a tendon or joint. It presents as a lump underneath the skin, which contains a jelly-like material that is typically thick, sticky, clear, and odorless. These cysts most commonly develop on the tendons of the wrist or hand, but can also appear on the ankle or foot. The exact cause is unknown, but injured joints or tendons are more likely to form a ganglion cyst. Ganglion cysts are usually painless; however, if a cyst presses on a nerve, it can cause pain, tingling, numbness, or muscle weakness. Asymptomatic ganglion cysts do not require treatment, and about half disappear without intervention. But with larger or symptomatic cysts, treatment may be recommended. Fluid inside the cyst may be aspirated to relieve pressure and pain, but it does not eliminate the cyst, and is associated with a high level of recurrence. Excision of the cyst can also be performed. It is more invasive, but generally has a lower level of recurrence. Here, we present the case of a pediatric patient with a ganglion cyst on her right wrist. Excision of the cyst was elected over aspiration in order to decrease the chance of recurrence.
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So there. And we lift it up Infiltrate a bit. You're seeing blanching. More anesthesia around. Okay. And then more anesthesia. And I go in laterally. You see it blanching up, filling up. And on the side. I think we've blocked most of it. If it's a ganglion cyst, this normally goes deeper into the sheath. You might have to reserve some anesthesia later. I just wait for it to take effect a bit for a few- 1-2 minutes, before we incise.
Now we will incise. This side. I'm trying not to pop it, I'm just going as superficial as I can.
And I try to get a Mosquito to insinuate it in between the skin and the cyst. Let's see if we can do that by avoiding it to pop. There you go. Okay, I just do it bluntly. Then we dissect it again on the other side. Blunt dissection. You can see it coming out, took a gel-like cyst wall. Blade, please. You have a good plane, incise this- tissue. So again, it looks like a ganglion cyst here. It looks like it's gel inside. And as mentioned, this normally goes deeper, in between the tendons. So sometimes it might be difficult to, to get this as a whole, and to dissect it underdeath because it's a little fixed. So what I do is, I- I make a small incision just to have the gel come out.
And sometimes it's easier to get as much of the cyst wall, once the gel is out, and avoid injuring structures underneath. So here, when you make an incision, You see it's like a gel-like, it's just clear. There. And you just wipe it off. I get the Mosquito. And I grasp that wall that I know I got- the cyst wall. That's the other side of my incision. Yeah, I wipe off and I squeeze off the Gel inside. and you can see it coming out, the gel. Squeeze more out.
Now since you've already removed this- most of the gel, it might be easier to dissect now, to get the inferior border, which is normally, as I mentioned, here, close to the tendons of the hand and the fingers. Because if we tried to get it while it's still full, we may injure structures underneath. There. And you just put it down. Push it down, and you can see this one here. Yes. Just keep it down a bit. Insinuate this mosquito underneath, to see if I got the whole thing from underneath. I look inside. Hold this. Then you open up, you'll see it still goes a little deeper. So, this patient is awake. She was looking at her wound a bit, and sometimes they have that reaction, they get a that little pale and they have a reaction that they want to vomit. So I told her to deep breathe, to practice deep breathing, and she should feel better a bit after that. So always, it might be best that your patient's lying down. Even if they say they're okay to do it, than watching. Here's some vessels, I'd rather just ligate it. So here, if you could look inside, you can look inside the cyst. There, you can see there- deep, very deep. I open up the cyst and see there- all the way down. So continue dissecting. You get as much- as much- cyst wall as I can. Here, stay inside of the cyst. I'm just going to ligate one of these small vessels. So I just continue dissecting, inside. There. Okay. So we'll go all the way down. We don't want to, since we're dealing with a benign tumor, I don't, I'm sorry. I don't normally want to go too deep. So by opening this, this cyst wall, maybe suturing the edges, making marsupialization would be best for her. Decrease the chance of… recurrence. So we look at this, look. The ganglion cyst goes all the way down.
So I just do- put some small sutures on the edges. Just like we were doing marsupialization Just for it to avoid closing. So here, I just put some hydrogen peroxide to- for 2 reasons. Coagulation- so it creates hemostasis in the area, and because reactional, so for the internal capsule. So we are closing, We don't close the cyst again, all because this will- increase its chance for recurrence.