Infected Thyroglossal Duct Cyst in a Neonate: A Report of a Rare Case

Abstract

Patient: Female, 3-week-old Final Diagnosis: Thyroglossal duct cyst Symptoms: Infection • neck mass • respiratory distress Medication: — Clinical Procedure: Incision and drainage • Sistrunk’s procedure Specialty: Otolaryngology • Pediatrics and Neonatology Objective: Congenital defects/diseases Background: Thyroglossal duct cysts are the most common congenital cervical anomalies, often presenting as midline neck cysts. The mean age of presentation of pediatric thyroglossal duct cysts varies between 5 and 9 years old, with rare cases younger than 1 year old. This case report details a rare case of an infected thyroglossal duct cyst presenting during the neonatal period as an upper airway obstruction. Case Report: A 3-week-old neonate born full-term with no complications during pregnancy or labor presented with a 5-day history of worsening nasal congestion and upper airway obstruction after an upper respiratory infection. Physical examination revealed a large midline neck mass measuring 3.1×4.2×3.2 cm abutting the hyoid with internal echogenicity consistent with a thyroglossal duct cyst, causing posterior tongue compression of the airway and airway distress. The patient was emergently taken to the operating room for incision and drainage, where she underwent a difficult intubation due to superior-posterior tongue displacement and global supraglottic edema. She was discharged on postoperative day 5 on a course of Augmentin after cultures grew methicillin-sensitive Staphylococcus aureus . The patient had no further complications, with successful excision using a Sistrunk procedure 6 months later. Conclusions: Pediatric thyroglossal duct cysts most often present as an asymptomatic midline neck mass, with rare sequel-ae of infection and upper airway obstruction. This case report highlights the pathophysiology and presenting symptomology of thyroglossal duct cysts, explores the rarity of infected thyroglossal duct cysts in neonates, and reviews the current literature on management strategies for these patients.

The Outcome of Surgical Removal of Thyroglossal Cyst in Children; Experience of a Decade

“…5 The thyroid gland moves down in its usual position in the neck below the thyroid cartilage anterior to upper trachea. A portion of this tract in which the thyroid gland moves down to it's final position may fill with mucus like fluid creating a TC 6 . The cyst can form anywhere along the thyroid's route of migration.…”

Clinical Characteristics and Prognosis of Infants and Children <3 Years of Age With Thyroglossal Duct Cyst Complicated With a Parapharyngeal Mass: A Case Series Study

“…Thyroglossal duct cysts (TGDCs) are congenital and developmental abnormalities that can occur at any age but are most common in infants and children between the ages of 1 and 10, 1 with rare cases <1 year of age. 2 Clinically, the patients often present a painless neck mass, and the most common location is near the hyoid bone, which is the midline neck in infants. 3 In adults, TGDC has the potential to develop associated malignancy.…”

Challenges in the Treatment of Laryngeal Cyst in a Baby Less than 2 Months Old: A Clinical Case Report

“…Laryngeal cysts are rare benign lesions, and when they cause upper airway obstruction, they can lead to Acute Respiratory Insufficiency and an even more dramatic clinical condition, such as Cardiopulmonary Arrest due to hypoxemia and death [5,6]. Laryngeal cysts are classified as saccular or ductal.…”

“…Saccular cysts are larger and are reported to be caused by the cystic distension of the laryngeal saccule, with a lower incidence, representing 25% of cases. In another group are ductal cysts that develop due to distension of obstructed glandular ducts, often being asymptomatic [6].…”

“…Lateral neck radiography assists in visualizing most cysts, but it is not used as the primary tool since computed tomography and magnetic resonance imaging are capable of providing better details regarding the size and precise boundaries of the lesions. Fiberoptic laryngoscopy can be used as a diagnostic tool, and direct laryngoscopy allows for visualization, confirmation, and treatment [4,6]. Although laryngeal cysts have a rare incidence, early diagnosis enables definitive treatment.…”