Neck mass- Thyroglossal cyst

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Dr. Money Gupta

Posted By : Dr. Money Gupta - MS, MCh (PGI) Pediatric and Neonatal surgery

Posted On : Apr 18, 2011 (Views : 3535)

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Thyroglossal cyst



Most Thyroglossal duct cysts present during the first 5 years of life.



  • Clinically, the uncomplicated cyst typically moves cranially with swallowing and protrusion of the tongue.

  • Dermoid cysts, the most likely item in the differential diagnosis.

  • The infected thyroglossal duct cyst usually resembles other abscesses, with intense erythema.

  • The most common pathogens are Haemophilus influenza, Staphylococcus aureus.




Site



Can occur from the base of the tongue to the lower midline.



  • 60% were located adjacent to the hyoid bone

  • 24% were between the hyoid bone and base of the tongue

  • 13% were between the hyoid and pyramidal lobe.

  • 3% were intralingual




Clinical/Features



  • One-quarter of these lesions present a draining sinus tract in the midline.

  • The thyroglossal duct does not communicate with the skin during development of the embryo.

  • Thyroglossal duct sinuses are thought to represent spontaneous rupture.

  • Alternatively, may result from surgical drainage of an abscess associated with a thyroglossal duct cyst.


Unusual presentations

    - respiratory distress

    - sudden infant death syndrome from lesions at the base of the tongue



Pathology



  • Lined by ductal epithelium

  • May contain solid thyroid tissue.

  • Approximately 1.5% of patients  have median ectopic thyroid at the time of surgery.

  • The only functional thyroid tissue is located within the mass.

  • Are frequently hypothyroid, with elevated TSH levels and resultant hypertrophy of the ectopic thyroid tissue.




Diagnosis and workup



  • Evaluation of these patients consists of a thorough history and physical examination.

  • FNAC

  • USG of the mass

  • Screening TSH

  • Scintiscanning (only in suspected ectopic thyroid)




Management



Virgin cyst---excision( Sistrunk operation)



Infected–   control with antibiotic  —  excision



    not control-- infection control ---aspiration(to isolate org.)



    not control---- I&D+ antibiotic--  excision                                                                           



If the mass represents the patient’s only functional thyroid tissue



it may be left in situ, divided and placed laterally below the strap muscles or autotransplanted to the rectus abdominus or quadriceps muscle.



Carcinoma



  • Incidence  less than 1%

  • Found incidentally at the time of surgical therapy for a suspected thyroglossal duct cyst

  • Most are papillary carcinomas.

  • The extent of surgical therapy ?

  • The Sistrunk procedure is considered  adequate surgical therapy for papillary carcinomas provided that there is no capsular invasion and no evidence of regional or distant metastases.


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