Pediatric Surgery: Thyroglossal Duct Cyst

Thyroglossal Duct Cyst

Basics

  • From Abnormal Descent of the Thyroid
  • Most Common Congenital Neck Cyst
  • Risk for Recurrent Infection (Primary Reason for Excision) & Malignancy
  • Ectopic Thyroid Tissue May Present Similarly

Presentation

  • Classic Presentation: Midline Mass Between Hyoid & Thyroid
  • Moves Up & Down with Swallowing
  • Can Communicate with Oral Cavity – May Cause Foul Taste or Infection
  • There is Variation
    • May Actually Lie Somewhat Lateral to Midline
    • May Have a Draining Sinus – More Commonly Associated with Branchial Cleft Cysts

Thyroglossal Duct Cyst 1

Diagnosis

  • Diagnosis: US (Some Prefer CT)
  • Must Confirm Presence of Normal Thyroid Tissue – May Consider TSH, Thyroid Scan or FNA

Treatment

  • Uncomplicated: Sistrunk Procedure
  • Infected: Antibiotics
    • May Require Aspiration or Incision & Drainage
    • Sistrunk Procedure Once Infection Controlled

Thyroglossal Duct Cyst on US 2

Thyroglossal Duct Cyst on CT 3

Sistrunk Procedure

  • Resect Cyst, Tract & Mid-Hyoid
  • Positioning: Supine with Neck Extended
  • Procedure:
    • Transverse Cervical Incision
    • Mobilize Cyst Along Its Tract
    • Divide Mylohyoid & Hyoglossus Muscle Attachments to the Superior Hyoid
    • Divide Hyoid 1 cm from Midline Bilaterally
    • Suture Ligate the Proximal Tract
    • Remove Specimen En-Bloc

Sistrunk Procedure 4

References

  1. Peter KD. Wikimedia Commons. (License: CC BY-3.0)
  2. Dilmen N. Wikimedia Commons. (License: CC BY-SA-3.0)
  3. Debnam JM. Imaging of the Head and Neck following Radiation Treatment. Patholog Res Int. 2011;2011:607820. (License: CC BY-3.0)
  4. Gebbia V, Di Gregorio C, Attard M. Thyroglossal duct cyst carcinoma with concurrent thyroid carcinoma: a case report. J Med Case Rep. 2008 Apr 29;2:132. (License: CC BY-2.0)