Atypical thyroglossal duct cyst

Thyroglossal duct cysts most frequently present in childhood as a painless midline swelling of the neck. Uncommonly, these embryonal remnant cysts present clinically in adult life. The majority of adults with thyroglossal duct cysts present with a swelling at the level of the thyrohyoid membrane. On rare occasions, a thyroglossal duct cyst can present with more sinister symptoms, such as hoarseness, dysphagia and dyspnoea. On these occasions, the pre-operative clinical and investigative diagnosis remains in doubt until histology is available.     

Endoscope-assisted concurrent resection of thyroglossal duct cysts and benign thyroid nodules via a small submental incisions

The objective of this study was to evaluate the technique of endoscope-assisted concurrent resection of thyroglossal duct cysts and benign thyroid nodules via a small submental incision. Endoscope-assisted thyroglossal duct cyst excision and subtotal thyroidectomy were performed via a small submental incision in six patients with thyroglossal duct cysts and benign nodular thyroid lesions. The thyroglossal duct cysts and thyroid lesions were completely excised. The incisions were 3–4 cm in length, and the mean operation time was 84 ± 11 min. The mean volume of blood loss was 19 ± 5 mL. Postoperative pathological examination findings confirmed the diagnosis of thyroglossal duct cyst in all patients. The thyroid lesions were nodular goiter in three patients and thyroid adenoma in three patients. No postoperative complications such as hematoma, pharyngeal fistula, hypocalcemia, recurrent laryngeal nerve paralysis, or dysphagia were observed. No changes in the planned surgical procedure were required, and no recurrent lesions were detected during follow-up. In conclusion, patients with thyroglossal duct cysts and benign thyroid lesions can be treated by endoscopic excision via a small submental incision, thereby avoiding large neck incisions and resulting in better postoperative cosmetic outcomes.     

Intralaryngeal thyroglossal duct cyst: implications for the migratory pathway of the thyroglossal duct

An atypically located thyroglossal duct cyst in a 42-year-old man is described. A purely intralaryngeal thyroglossal duct cyst is extremely rare and can mimic other laryngeal lesions. This case demonstrates that thyroglossal duct cyst is a possible cause of intralaryngeal swellings and would have significant implications for the manner in which they are managed.     

Endolaryngeal extension of thyroglossal duct cyst

Thyroglossal duct cysts are the most common congenital neck masses that develop during childhood, The masses develop from remnants of thyroglossal ducts, and typically appear as midline neck masses. Endolaryngeal extension of thyroglossal duct cysts has been reported mostly as midline neck swelling. We observed a case of extension of the thyroglossal duct cyst to the supraglottic area without neck swelling. A 50-year-old man presented with a 1-month history of foreign-body sensation in the throat. Fiberscopic and radiologic findings were similar to those associated with a saccular cyst, but its proximity to the hyoid bone raised the possibility of thyroglossal duct cyst. Operation was performed via an external incision to completely remove the cyst. Postoperative fiberscopy revealed that the aryepiglottic fold swelling had disappeared. Diagnosis of thyroglossal duct cyst was confirmed on the basis of pathological findings. In cases in which it is difficult to remove the cyst from the hyoid membrane, the hyoid bone midline portion should be dissected. Thyroglossal duct cysts should be considered in cases with a submucosal tumor in the supraglottic region, and radiological examinations should be performed.     

Papillary carcinoma on thyroglossal duct cyst

Papillary carcinoma ansing on a thryroglosal duct cyst is a rare tumor. Since Ucherman described first case in 1915, only 150 cases have been reported. We present clinic evolution and treatment of a new case and review literature and discussion about tumor origin, adequate diagnosis test and treatment. This should include Sistrunk procedure but further surgery on thyroid gland is not accepted by all authors.     

甲状舌管残留临床分析

目的　探讨甲状舌管囊肿及瘘的复发因素及治疗情况。方法　回顾性分析我科2010年1月～2013年3月收治的114例甲状舌管囊肿及瘘患者的临床资料。结果　所有病例均经手术治疗,其中113例行Sistrunk术式切除,1例单纯囊肿切除,术后均一期愈合,随访6～46个月,3例复发,其中2例成人再次行Sistrunk扩大根治术,术后未再复发。结论　误诊、非典型的甲状舌管残留、急性感染时行手术、病变组织切除不完全、手术年龄过小和术中囊肿破裂是导致术后复发的重要因素,术前抗感染及术中对舌骨及残端的处理是治疗与防止复发的关键。     

Papillary carcinoma of the thyroglossal duct cyst in childhood

Thyroglossal duct carcinoma is a rare malignancy that is usually diagnosed postoperatively. Approximately 150 cases have been reported in the literature. Eighty-five percent of these were papillary carcinomas. Controversies exist concerning its nature and treatment. In this report, we present an 11-year-old boy with an anterior cervical cystic mass originating in the thyroglossal duct. After a primary Sistrunk procedure, the cyst and tract extending to the foramen caecum at the base of the tongue in continuity with the midportion of the hyoid bone were resected. Histopathologic study demonstrated a papillary carcinoma. After 4 months of follow-up, the patient is asymptomatic without any evidence of recurrence. The clinical and histopathological features and therapeutic options are discussed.     

Cricoid injury complicating excision of thyroglossal duct cyst

The Sistrunk procedure is the treatment of choice for thyroglossal duct cyst excision (TGDC) due to its low recurrence rate and incidence of minor complications. Given the proximity of TGDC to the airway, injury to the laryngotracheal cartilages during this procedure is possible. We report a case of a 2-year-old girl transferred to our institution who had a cricoid cartilage injury during a Sistrunk procedure. The pattern of injury, its treatment and outcome in our patient, as well as preventative measures are described. To our knowledge, this is the first report describing injury to the cricoid cartilage following this procedure.     

Transoral surgery for an infant thyroglossal duct cyst

A 2-month-old female infant with respiratory distress, cyanosis and swallowing difficulties following birth was referred to our hospital by the pediatric clinic. Flexible fiber optic laryngoscopic examination of the patient revealed a red–purple smooth-surfaced mass inside the tongue base and vallecula. No additional features were identified by otorhinolaryngological examination. A 2-cm cystic mass located at the tongue base was identified by neck computed tomography (CT) imaging. The cystic mass was marsupialized transorally with the assistance of the da Vinci robotic surgery system (TORS) and histopathologically diagnosed as a thyroglossal duct cyst. Surgery was completed with TORS without complications and prolonged intubation was extubated carefully. No respiratory distress or other complications were observed. All symptoms were completely resolved with surgery and the patient was discharged on the third postoperative day. The patient is still undergoing follow-up and no recurrence has been observed up to the eighth post-operative month.     

Concurrent thyroglossal duct cyst and dermoid cyst in two pediatric patients

Truly concurrent presentation of a thyroglossal duct cyst and a dermoid cyst has not been reported in the literature. The purpose of this study is to present two case reports of such presentation and to perform a literature review on the subject. We suggest that the entire neck should be imaged if the patient is to undergo diagnostic ultrasound or computed tomography to rule out the presence of a second neck mass.     

Unusual CT appearance of a thyroglossal duct cyst carcinoma

This is the first report to describe the CT appearances of a solid midline cervical mass that proved to be a papillary carcinoma associated with a thyroglossal duct cyst.     

Subglottic thyroglossal duct cyst: a rare intralaryngeal presentation

Thyroglossal duct cysts are common midline neck swellings that can present at any site along their migratory pathway. They are frequently situated just below the hyoid bone. Extension to the subglottic area is very rare; such an unusual presentation can complicate the diagnosis of a thyroglossal duct cyst. We report the case of a 30-year-old man who presented with a subglottic thyroglossal duct cyst and associated laryngeal symptoms. To the best of our knowledge, only 2 similar cases have been previously reported in the literature, both of which occurred in 2-year-old boys. We believe, therefore, that ours is the first reported case of a subglottic thyroglossal duct cyst in an adult. We discuss the clinical presentation, diagnosis, and treatment of our patient, and we summarize the literature on intralaryngeal thyroglossal duct cysts.     

Lymphoma mimicking a thyroglossal duct cyst in an adolescent

Mass lesions of the head and neck in infants and children can be either developmental, inflammatory or neoplastic. Lymphomas (Hodgkin's or Non-Hodgkin's) commonly present as neck lumps in children. Although malignancy is not the commonest aetiology of paediatric cervical lumps, a high index of suspicion is critical to facilitate early diagnosis and treatment of cervical lesions. We present the case of a 15-year-old boy who presented with a solitary midline cervical lesion, which simulated a thyroglossal cyst on clinical examination. However, histopathological examination revealed it to be a Hodgkin's lymphoma. Related literature is also reviewed.     

Obstructive lingual tonsil hypertrophy in recurrent thyroglossal duct cyst

The association between recurrent thyroglossal duct cyst (TGDC) and obstructive lingual tonsil hypertrophy has not previously been discussed. We present the case of a 7-year-old child whose medical and surgical course was complicated by these synchronous factors. The aim of this report is to present the risk factors for recurrence of TGDC and the unique challenge that concurrent lingual tonsil hypertrophy and airway obstruction present to management of patients.     

A ten-year experience of thyroglossal duct cyst surgery in children

We discuss a 10-year experience of all the thyroglossal duct cysts (TGDC) removed at our institution, assessing whether management was appropriate and to compare our outcomes and success rate with current literature. We performed a retrospective review of TGDC surgery at our institution from 2000 to 2010. During the study period, 93 children were identified as having had a TGDC excision at an average age of 6.1 (1.1–15.3) years. Seventeen cases (18 %) were found to have not had their hyoid bone removed and of these 10 (59 %) were proven on histology to be non-TGDC. A total of 19 cases were confirmed TGDC on histology but received a non-Sistrunk’s procedure and 12 (63 %) of those recurred requiring a more definitive procedure (i.e. Sistrunks). Of the 76 (82 %) that did have their hyoid bone removed 13 (17 %) suffered complications of which 3 were recurrences (3.9 %), which is comparable to the literature (3–5 %). Of the complications that occurred 11 out of 13 (85 %) were infected cases at or around the time of procedure. Our experience, being the largest described in the United Kingdom supports the use of Sistrunk’s procedure with recurrence rates comparable to that within the literature.