Thyroglossal Duct Cysts: A Clinicosurgical Experience

Abstract

Thyroglossal cyst is the most common congenital neck mass and occurs in 7% of the population. They occur due to failure of thyroglossal duct to involute and atrophy thyroglossal duct cysts often occur in pediatric patients. Majority of them are found infrahyoid region. The purpose of the present study is to report our 5 year clinical experience of thyroglossal cysts in terms of clinical features and surgical findings with special emphasis on naked eye extend of patent thyroglossal duct when present. To the best of our knowledge this is first clinical study which has reported the extend of thyroglossal duct on naked eye. This prospective observational study was done in the Postgraduate Department of ENT, Head and Neck surgery of Government medical college, Srinagar for a period of five years from January 2011 to January 2016. Thirty patients of histopathologically confirmed thyroglossal cysts were enrolled in the study. Patients were initially diagnosed on the basis of clinical history, examination and USG findings suggestive of cyst. Clinical data and surgical data in terms of size and location of cyst, presence or absence of thyroglossal duct etc. was analyzed and formulated in tables for patients who had histopathologically confirmed cyst. Mean age was 10 years. Majority (73.3%) were less than 15 years of age. Males were 22 in number (73.3%) while females compromised 26.7% of population. Ninety percent of patients presented with neck swelling. Erythema/redness over swelling was seen in 13.3% of patients. Majority (83.3%) of cysts were subhyoid in location. Thyroglossal ducts were seen to be patent for different lengths and areas. Majority of patients (80%) had tract arising from cyst and disappearing at superior border of hyoid body while three patients (10%) had patent thyroglossal duct from cyst to vallecular mucosa. A complete patent thyroglossal duct was seen in one patient (3.3%) from cyst to base of tongue. Complete Absent tract was seen in two patients (6.7%). Majority (70%) of cysts were having size between 1.6 and 3 cm. Intraoperative 10% of cyst got ruptured. Thyroglossal cysts are most commonly seen in pediatric males. Most of them present with visible midline neck swelling. In few cases cyst can rupture after repeated infections leading to sinus formation. Most of them are subhyoid in location. These cysts are usually of size 1.5-3 cm. Complete patent thyroglossal duct from cyst to tongue musculature is rarely seen while most of the times, a patent duct just disappears at the superior border of body of hyoid. None of our cysts had malignant features.

Diagnostic and surgical evaluation of thyroglossal duct cyst and fistula patients: Seven year experience of our clinic

“…In some studies, it was found that the male-to-female ratio is the same, whereas in some studies, there is male predominance. [2,5,6] In our study, 49 (53.8%) were males, and 42 (46.2%) were females, which shows male predominance.…”

“…Therefore, a thyroglossal cyst may be seen at any place along this remnant duct. [2] In a study, thyroglossal duct cysts were in 60% of cases located adjacent to the hyoid bone, 24% between the hyoid bone and base of the tongue, 13% between the hyoid bone and the pyramidal lobe of the thyroid, and 3% were intralingual. [9] Sometimes, this cyst can get infected and cause a sinus between the cyst and the skin causing TF.…”

“…It involutes after five weeks of gestation. [2] Any defect in involution may result in a thyroglossal duct cyst or its remnant. Therefore, TGDCs may be found anywhere on this migrant tract.…”

Dual thyroid ectopia: A pictorial case series and review of literature

“…TGD cyst is removed usually by the Sistrunk operation, which involves removal of the cyst along with the tract, body of the hyoid bone, and core tissue up to foramen cecum. [ 16 ]…”

Outpatient management and surgeon specialty for thyroglossal duct cyst excision: A retrospective analysis of 377 patients and 30‐day outcomes in the American College of Surgeons NSQIP‐P Database

“…Thyroglossal duct cysts (TGDC) are common congenital anterior neck anomaly, occurring in approximately 7% of the population . The defect consists of a fibrous cyst left by a persistent embryologic thyroglossal duct . Surgical excision may be indicated to prevent infection or cosmetic defects; the Sistrunk procedure remains the standard approach and is usually performed by an otolaryngologist or general surgeon …”