Thyroglossal Duct Cysts Information
What is Thyroglossal Duct Cysts ?
Thyroglossal duct cyst is a disease which is very rare. Thyroglossal duct cyst (TDC) is the most common congenital anterior midline neck mass usually (2/3 of cases) presenting before the second decade of life. Symptoms appear at an average age of four with the sudden appearance of a cystic mass at the angle of neck level moving with tongue protrusion and swallowing. Males are more commonly affected than females.
Thyroglossal duct cyst is an embryologic anomaly arising from epithelial remnant left after descent of the developing thyroid from the foramen cecum. The lining is cuboidal, columnar or pseudostratified epithelium.
Thyroglossal duct cyst is associated to discomfort, infection and a slight probability of malignancy. A legally protective requirement is to document that the mass is not ectopic thyroid gland. Diagnosis is physical. Sonograms will show a cyst between 0.4 and 4 cm in diameter, with variable sonographic appearance and no correlation with pathological findings of infection or inflammation.
Thyroglossal Duct Cysts
Sign and Symptom
Thyroglossal duct cysts most often present with a palpable (able to be felt) asymptomatic midline neck mass at or below the level of the hyoid bone. The neck mass moves with swallowing. Some patients will have neck or throat pain, or dysphagia (difficulty swallowing). The spectrum of clinical symptoms may be as varied.
- a small, soft, round mass in the center front of the neck
- a small opening in the skin near the mass, with drainage of mucus from the cyst
- difficulty swallowing or breathing
- tenderness, redness
Treatment of Thyroglossal Duct Cysts
Once infected surgical excision is more difficult and recurrence will increase. Management is Sistrunk's operation: Excision of cyst with resection of duct along with the central portion of hyoid bone (a minimum of 10-15 mm of hyoid bone should be removed) and some muscle surrounding the proximal ductules (the length of single duct above the hyoid bone spreads into many ductuli as it approach the foramen cecum). Extensive dissection can cause pharyngodynia. The greatest opportunity for cure is surgery at initial non-inflamed presentation. Inadequate excision is a risk factor for further recurrence.
Treatment may include:
- surgical removal of the cyst and the thyroglossal duct, called the Sistrunk procedure
- antibiotic medication (to treat the infection)