Infected Thyroglossal Duct Cyst on The Neck

Thyroglossal Duct Cyst (TGDC)

Infected Thyroglossal Duct Cyst (TGDC) on The Neck

Thyroglossal duct masses are congenital cystic lesions located in the midline of the neck and moving with swallowing. They often occur after upper respiratory tract infection. As seen in the patient in the photograph, they may rarely infect out of the skin. The thyroglossal canal cyst is a fluid-filled sac located just above the larynx in front of the neck. This cyst develops from a tissue remaining from the development of the thyroid gland, present at birth, but usually occurs in childhood or in young adults.

Thyroglossal duct cyst general information

Thyroglossal duct cyst is the most common congenital neck mass in children. They usually present in the age range of 2-10 years. However, thyroglossal canal cyst is also common in adults. Thyroglossal duct cyst during the descent of the thyroid from the tongue base into the neck. It occurs as a result of lack of partial or complete obliteration in the thyroglossal duct. The foramen can be seen in any localization from the cecum to the sternum. It is located on 70% hyoid bone, 20% submental, rarely suprasternal, linguala, lateral. Maligninization is rare. It shows itself as a painless, mobile, smooth surface, soft, mass. If infected, pain, difficulty swallowing and skin hyperemia, fistula may occur.

How does it occur?

The thyroid gland is located behind the tongue while the fetus is in the womb. Then, under the tongue, the hyoid migrates through the bone to the lower part of the neck. At this time, it forms a thin channel called the thyroglossal duct. This duct should disappear when the thyroid gland reaches its final position in the neck. Thyoglossal cyst is formed with the accumulation of fluid in the canal.

Symptoms of infected thyroglossal duct cyst

Mostly there is a soft mass in the middle of the neck that moves vertically by swallowing and sticking tongue out. If infection is added, there may be redness and tenderness in the skin of the neck. If the infection opens out, discharge from the skin of the neck may occur. Large cysts may cause difficulty in breathing and swallowing.

Diagnosis of thyroglossal duct cyst

In the diagnosis, removal of the tongue outward and movement of the mass during swallowing are pathognomonic. The channel to which it is connected passes through the middle of the tongue bone (hyoid bone), so it moves up and down as it rises. This finding is called "Sistrunk Finding".
Utrasonography or CT provides information about the nature and neighborhood of the cyst.
Thyroid tissue is detected by scintigraphy. Since the mass in the neck may be aberrant thyroid tissue, normal thyroid tissue may not have developed. Therefore, thyroid gland is seen in normal position and structure by thyroid scintigraphy. This may be the only thyroid tissue in the patient and may remain thyroid free after surgery Imaging methods are important in determining their size and neighboring surrounding tissues.

Differential diagnosis for thyroglossal duct cyst

In the differential diagnosis, the following conditions that may cause neck swelling or mass should be considered:
  • Dermoid cyst
  • Epidermoid cyst
  • Branchial cyst
  • Thyroid pyramidal lobe hyperplasia and cysts,
  • Lipoma
  • Ectopic thyroid tissue
  • lymphadenopathy
  • Sebaceous cysts
  • Hamartoma
  • Teratoma

Treatment of thyroglossal duct cyst

Surgical treatment is applied. In the treatment, the middle part of the hyoid bone is removed by following the duct along with the cyst, and this operation is called "Sistrunk Operation". The treatment of thyroglossal duct cysts is surgery. The pathology of the extracted tissue also makes the definitive diagnosis. In this way, the possibility of “thyroglossal cyst cancer nadir which can occur rarely is understood.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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