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Two patients with thyroglossal duct cysts have been studied with CT and MR. The typical CT feature of these cystic upper-neck lesions are depicted in literature, conversely MR findings are not well known. The homogeneous high intensity on T1-weighted images, higher than simple cyst or fluid, is the most typical feature of the thyroglossal cyst.
Thyroglossal duct cyst (TGDC) is one of the more common causes of a pediatric neck mass. Lingual TGDC, which is located at the base of the tongue, is an unusual variant. Because of the oral pharyngeal location, lingual TGDC may cause dysphagia and respiratory distress. Previous investigators have advocated the use of a formal Sistrunk procedure for lingual TGDC. Herein the authors describe three children with a lingual TGDC in whom marsupialization of the cyst was performed, without excision. The follow-up period ranges from 2 to 5 years, and there has been no recurrence. Because of the low morbidity and high success rate associated with this approach, the authors recommend it for the treatment of lingual TGDC.
Thyroglossal duct cysts and branchial cleft anomalies are important in the differential diagnosis of cervical lesions. Both lesions are common and are seen more commonly in the child than in the adult. Considerable discomfort and morbidity may be associated with severe infections occurring in both of these lesions. Of importance is the observation that once these congenital cysts become infected, subsequent surgical removal is very difficult, and recurrence may result. For these reasons it is essential that the clinician become familiar with the embryology of these lesions, which is vital to the understanding of them. In addition, the development of skills in diagnosing and managing this condition is essential.
Thyroglossal duct cysts are the most common nonodontogenic cysts to occur in the neck, and they often are situated in close proximity to the larynx. Despite this, they almost never present as an intralaryngeal mass. Three cases are cited in which intralaryngeal examination suggested that a larynx lesion was present. In two cases, a submucosal supraglottic mass was seen, while in the third case, the thyroid cartilage was eroded and a laryngeal malignancy was suspected. The role of CT in diagnosing and mapping these tumors is discussed.
Papillary carcinoma arising in a thyroglossal duct cyst is a rare tumor. We report the case of 64-year-old man treated for thyroglossal duct cyst. Preoperatively, the thyroid gland was normal on physical examination and imaging studies. The Sistrunk procedure was done. The histopathological examination revealed thyroid papillary carcinoma. Postoperatively thyroid hormon was given to suppress serum TSH levels and the patient was followed at regular intervals. During a 5-year follow-up period, no recurrence of the disease occured.
OBJECTIVE: The recurrence rate of thyroglossal duct cysts removed by the classic Sistrunk procedure exceeds 4%, even in skilled hands. Simple reexcision fails in 33% of these patients. Recent pathology literature suggests that the tracts of thyroglossal duct cysts may arborize, arguing for a wide-field approach to recurrent lesions. We describe the anatomic rationale and technique of an en bloc central neck dissection in children, on the basis of cadaver dissections and histopathologic review of recurrent thyroglossal duct cyst specimens. METHODS: We reviewed the medical records of all the children undergoing surgery for thyroglossal duct cysts and fistulas during the years 1990 to 1998 by the senior author. En bloc central neck dissections were performed on several cadaver specimens to further delineate the anatomic rationale for this procedure. RESULTS: We have performed an en bloc central neck dissection in 7 children, 5 with recurrent or multiply recurrent thyroglossal duct cysts. None has had a recurrence after follow-up of 9 months to 6 years. All have acceptable functional and cosmetic results. CONCLUSION: An en bloc central neck dissection is a logical and effective surgical technique for the removal of recurrent or multiply recurrent thyroglossal duct cysts.
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An instance of thyroglossal duct cyst in a 68-year-old man was reported. The clinical diagnosis of a thyroglossal duct cyst is suggested by the presence of a cystic mass situated anteriorly in the midline of the neck regardless of the patient's age. A review of the literature revealed that the incidence markedly decreases with age, with the great preponderance of cases occurring in infancy and childhood. Fourteen cases of thyroglossal duct cyst have been reported in the over-60 population.
BACKGROUND AND AIMS: Thyroglossal duct cysts (TDC) in children have a variable sonographic appearance. Some reports have suggested that TDCs appear on ultrasound as well defined, cystic masses with thin walls and posterior enhancement, whereas others have documented a heterogeneous echopattern within these lesions. In our experience, although TDCs in children have a variable ultrasound appearance, the most common appearance is that of a pseudosolid mass closely related to the hyoid bone. In this study we report on 23 patients with thyroglossal duct cysts and document the ultrasonic patterns. PATIENTS AND METHODS: All patients in whom the diagnosis of TDC was made clinically (by at least two head and neck surgeons) and in whom ultrasound detected a cystic mass related to the hyoid bone, were included in this study. Sonograms of 23 children with TDCs were reviewed. The features evaluated included their location, internal echogenicity, posterior enhancement, the presence of septa, a solid component and a fistulous tract. The echopattern was not correlated with the biopsy results. RESULTS: Three patterns of TDCs were identified: anechoic (13%); pseudosolid (56.5%); and a heterogeneous pattern (30.5%). The majority were midline (82.6%), showed posterior enhancement (56.5%), and had thin walls (82.6%). CONCLUSION: On ultrasound, TDCs in children are not simple cysts but have a complex pattern ranging from a typical anechoic cyst to a pseudosolid appearance (most common).Ahuja, A. T. (2000). Clinical Radiology55, 770-774.
Fifty-one patients operated for thyroglossal duct cyst at the Ear, Nose and Throat Department of the Zadar General Hospital in the period from 1981 to 1996 were retrospectively analyzed. Thyroglossal duct cyst occurs most commonly in childhood, but it can also appear in adults, even in the elderly persons. The cyst is always localized at the medial neck line, most often beside the lingual bone. The first symptom of the disease in the majority of patients was a painless tumor on the neck. Less frequently, the first symptoms were difficulties in swallowing and signs of infection: pain, redness and swelling on the neck. In majority of patients the diagnosis was established by inspection and palpation, and confirmed by puncture and cytologic examination. In two patients, in whom the site of the cyst was behind the lingual bone, the diagnosis was established by ultrasound. For the diagnosis of thyroglossal duct cyst, physical examination with cytologic evaluation and ultrasound are generally sufficient. Only exceptionally, gamma scintigraphy of the thyroid gland and CT of the neck should be done. After comparing the results of several surgical methods, the author recommends that in addition to the removal of the cyst, the trunk of the lingual bone should be removed as well, to minimize the likelihood of a recurrence.
PURPOSE: This procedure for thyroglossal duct cyst operation based on pathological studies was first published in the Journal of Pediatric Surgery in 1992. This procedure is similar to Sistrunk's operation except that the core depth of the tongue excision is more shallow (about 5 mm in young children). The purpose of this report is to report and evaluate the clinical results of this operation compared with our earlier operative results. METHODS: Eighty-three patients underwent surgery for thyroglossal duct cyst from 1970 to 1997. They were divided into 3 groups. Group I consisted of 31 patients undergoing Schlange's operation (1970 to 1988). Group II were 18 patients undergoing Sistrunk's operation (1989 to 1990). Group III consisted of 34 patients operated on with the authors' procedure (1991 through 1997). The 3 groups are compared for recurrence rate. RESULTS: Recurrence in group I was 6 of 31 (19.3%), 1 of 18 (5.6%) in group II, and 1 of 34 (2.9%) in group III. The recurrence rate showed a statistically significant difference only between group I and III (P = .033). CONCLUSION: The recurrence rate with our procedure was not higher than that of Sistrunk's operation but was significantly lower than for Schlange's operation.
Persistence and dilation of the embryologic thyroglossal tract gives rise to the condition of thyroglossal duct cyst. Although these cysts have an embryologic origin, there is rarely a history of inheritance. A search of the literature shows only two family reports, which includes a total of nine patients. We report on a third family with thyroglossal duct cyst in two members. The patients were female siblings aged 2 and 6 years, both of whom underwent successful surgical excision of their thyroglossal duct cysts by modified Sistrunk's technique.
The authors review the embryological, clinical and therapeutic aspects of congenital facial and cervical cysts (C) and fistulae (F), based on a personal series of 85 cases (facial: 18, latero-cervical: 29, mediocervical: 38) observed during a 5-year period. The facial forms are the result of an incomplete coalescence of the facial buds and most often present as helical F (17/18). Laterocervical C and F are due to abnormal evolution of branchial clefts; the main clinical forms are related to anomalies of the 2nd branchial cleft (24/29), usually presenting as sinus localized at the anterior border of the lower third of the sternocleidomastoid muscle (8) and amygdaloid cysts. Thyroglossal duct cysts are the most frequent of the medio-cervical C and F (35/38); they usually present as a mediocervical cyst in the thyro-hyoid space which may be revealed by an infection or a fistulization. The only appropriate treatment of congenital facial and cervical C and F is surgery providing that the resection is meticulous with complete resection of the fistula in order to avoid relapse. Complete resection also suppresses the risk of secondary malignant degeneration of amygdaloid and thyroglossal duct cysts.
Thyroglossal duct cysts, though not uncommon, rarely present with evidence of laryngeal compromise. The case presented is one of the very few cases with documented laryngeal invasion reported in the English language. Of clinical significance is the patient's presentation with laryngeal symptoms of choking and dysphonia in the presence of a small anterior cervical mass. While the thyroglossal duct cyst usually presents as an asymptomatic anterior neck mass, this case illustrates the importance of considering a thyroglossal duct cyst in any patient with airway compromise in the absence of a neck mass.
A benign neck mass was discovered in a young child which, based on presentation, was diagnosed as a thyroglossal duct cyst. Thyroglossal duct cysts normally appear in childhood and are usually asymptomatic. They are a congenital neoplasm resulting from incomplete resorption of the thyroglossal duct following the embryonic descent of the thyroid gland and are often found attached to the hyoid bone. They may or may not have exterior fistulae and are slow growing. Other types of neck masses should be included in a complete differential diagnosis, as this case verified. Masses such as the dermoid cyst may be misdiagnosed as TGDC. While also slow growing, and presenting similarly to the TGDC, dermoid cysts may enlarge and compromise airways and interfere with eating and swallowing. Treatment of choice for these neck masses is excision including ductal remnants. Care must be taken not to remove ectopic thyroid tissue if that is the entire extent of the patient's thyroid gland. This case presentation exemplifies the role of the dental hygienist in identifying lesions of the head and neck and seeking appropriate referral when indicated. The dental hygienist if ideally suited to perform complete extraoral and intraoral examinations by virtue of education and training. Routine examinations must extend beyond the intraoral structures to include the head and neck regions. One must not assume that pathology exists only in the older population.
A case of intrathyroid thyroglossal duct cyst is reported. A 50-year-old woman presented with a right lateral neck mass that was clinically indistinguishable from a thyroid nodule. Ultrasound-guided fine-needle aspiration biopsy (US-FNAB) revealed normal-looking squamous cells. Right thyroid lobectomy was performed and microscopic examination revealed a cyst lined by squamous epithelium that was consistent with a thyroglossal duct cyst. The lesion was completely surrounded by normal thyroid tissue. Our experience suggests that intrathyroid thyroglossal duct cyst should be remembered in the differential diagnosis of a thyroid nodule. Detection of benign squamous cells by US-FNAB may be useful for ruling out the possibility of a cystic thyroid tumor.
We report a thyroglossal duct cyst with calcification, the second case in the world literature. The ultrasound and CT findings are described and we highlight the differential diagnosis.