Letters to the Editor

Dear Sir,

We read with great interest the recent article by Jagers Op Akkerhuis et al. “Hyaluronidase versus surgical excision of ganglia: a prospective randomised clinical trial”. This study involved patients being randomly allocated to surgical excision, or injection of hyaluronidase followed by aspiration after 1 min. Not surprisingly the recurrence rate was 77% in the group undergoing aspiration after administration of hyaluronidase.

In their discussion Jagers Op Akkerhuis et al. (2002) state that their recurrence rate of 77% in the group treated with hyaluronidase after aspiration is higher than that reported in a previous study performed by our group. In our study (Paul and Sochart, 1997) we compared the recurrence rate in 35 patients who had hyaluronidase injection and aspiration followed by a steroid injection and a steroid injection alone. Our recurrence rate was 51% at 2 year follow-up after hyaluronidase injection, aspiration and corticosteroid injection, compared with 80% for the group which were treated with corticosteriod injection only.

This misrepresents our study completely and our results are not directly comparable to those of Jagers Op Akkerhuis et al. Our patients had steroid injected into the ganglion after aspiration whereas in their study no steroid was injected.

It is interesting to note that 89% of our patients whose ganglia were injected with hyaluronidase, aspirated after 1 min and then injected with steroid had a good or excellent result after 2 years, and there was no palpable or residual swelling in 49% of these cases. This demonstrates that this method is clinically effective, and it requires little expense, equipment or time, and can be performed in the outpatient department. It also provides an excellent result in terms of patient satisfaction with minimal cosmetic scarring.