Neck Mass- 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.
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
- 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.
- respiratory distress
- sudden infant death syndrome from lesions at the base of the tongue
- 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.
- USG of the mass
- Screening TSH
- Scintiscanning (only in suspected ectopic thyroid)
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.
- 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.