Preoperative thyroid scanning in presumed thyroglossal duct cysts.

The purpose of this study was to determine if preoperative thyroid scans are essential in the workup of presumed thyroglossal duct cysts. Questionnaires were sent to pediatric otolaryngologists and pediatric general surgeons with a 65% response rate. Fifty-seven percent of the physicians have encountered ectopic thyroid. In 58% of these, this was the only functioning thyroid tissue. Twenty eight percent of pediatric surgeons vs 65% of pediatric otolaryngologists routinely order scans. Two of the physicians encountering ectopic thyroid volunteered that they had successful litigation directed against them for removing the sole functioning thyroid and creating permanent hypothyroidism. There is a likelihood of encountering ectopic thyroid during the course of one's practice. A case of ectopic thyroid is presented, and management strategies are discussed.     

Vagaries of thyroglossal duct cysts

The thyroglossal duct cyst is the most common congenital cyst found in the neck, classically presenting as a paramidline mass in a healthy young adult. Fifty-three cases managed at the Brigham and Women's Hospital and Boston's Beth Israel Hospital over the past 10 years were reviewed. The unique presentation of papillary adenocarcinoma in TGDCs and findings in the elderly population are discussed. These cases represent both diagnostic and therapeutic challenges. The existing literature is correlated with our data, providing a treatise on management.     

Presentations of thyroglossal duct cysts in adults

The thyroglossal duct cyst is the most common congenital neck mass, resulting from persistence and dilatation of remnants of an epithelial tract formed during migration of the thyroid during embryogenesis. Approximately 7% of the population has thyroglossal duct remnants. Although thyroglossal duct cysts generally present clinically in children, it is important to understand that the lesion can present in adults as well, sometimes much later in life. Incidental carcinoma of the thyroglossal duct cyst is rare, but is more likely to occur in adults than children. Between 1991 and 1998, 11 cases of thyroglossal duct cysts were seen in adult patients at Georgetown University Medical Center, including 2 cases containing papillary carcinoma. This report discusses their clinical presentations and management. Received: 11 September 1998 / Accepted: 23 October 1998     

Management of incidental thyroglossal duct cysts during laryngotracheal reconstruction

Thyroglossal duct cysts originate from trapped elements of the thyroglossal duct tract during embryological descent of the thyroid gland. The incidental finding of a thyroglossal duct cyst during cervical surgery has not been described previously. We present four cases of small asymptomatic thyroglossal duct cysts discovered as an incidental finding during laryngotracheal reconstruction. In each case, the cyst was removed using a Sistrunk procedure. In all four cases the patient was successfully decannulated, and there were no cases of cyst recurrence. We also consider the implications that these four cases may have on the perceived incidence of the thyroglossal duct cysts and their management.     

超声对特殊部位甲状舌管囊肿的诊断价值

目的探讨超声对于特殊部位甲状舌管囊肿的诊断价值。方法回顾性分析超声图像资料,总结特殊部位甲状舌管囊肿的超声表现并判断超声对病变诊断的准确性。结果 5例位于舌根部,1例位于声门下,超声显示率100%,超声定位准确率100%。超声表现:肿块大小1.1 cm×1.1 cm×1.2 cm～2.4 cm×2.2 cm×1.9 cm;均为类圆形;6例(100%)均为薄壁;4例(67%)内呈无回声,2例(33%)呈均匀低回声;5例(83%)为单房、无分隔,1例(17%)为多房、有细小分隔;后方回声均增强;所有肿块内部及周边均未见血流信号。结论舌根部和喉内甲状舌管囊肿易导致儿童气道梗阻,超声对舌根部和喉内甲状舌管囊肿定位准确,有助于明确病变范围。     

Incidental radiographic findings of thyroglossal duct cysts: Prevalence and management

Objectives/HypothesisTo determine the epidemiology of incidental thyroglossal duct cysts (TGDC) discovered on imaging studies obtained in the head and neck area in children and to discuss subsequent management.MethodsA retrospective chart review was performed at Texas Children's Hospital of all computed tomography (CT) and magnetic resonance (MR) imaging studies obtained in the head and neck region between July 2011 and July 2014. Images obtained for the purpose of evaluating a neck or lingual mass were excluded from the study, as were patients with previously known TGDCs. Data including age, sex, location of TGDC, size, presence of symptoms, referral to Otolaryngology, and intervention were recorded.ResultsA total of 60,663 CT and MR studies of the head, brain, sinus, neck, and C-spine during this time period were reviewed; of these 69 (0.1%) cases contained incidental discovery of probable TGDCs with more males (40) than females (29). Ages ranged from 3 days to 17 years old, with the mean age at 5 years. Locations varied, with majority at base of tongue (83%) followed by hyoid (13%) then infrahyoid straps (4%). Sizes ranged from 2 to 28 mm with average size at 8 mm. 11 of these patients were referred to an Otolaryngologist; 9 were asymptomatic and decision was made to observe, the other two subsequently underwent surgical excision secondary to mass effect and dysphagia with histologic confirmation of diagnosis.ConclusionTGDCs commonly present as an anterior neck mass, however the majority of incidentally discovered TGDCs on imaging are located at the base of tongue. Management of these findings should include referral to an Otolaryngologist for further evaluation with the decision to intervene surgically based on development of clinical symptoms.     

Characteristics of lingual thyroglossal duct cysts under flexible laryngoscopy and treatment approaches

ObjectivesLingual thyroglossal duct cysts (LTGDCs) are clinically rare and easily misdiagnosed as epiglottic cysts. Misdiagnosis leads to mistreatment; thus,simple diagnosis is important. This study aimed to investigate the characteristics of LTGDCs with flexible laryngoscopy and imaging, improve their diagnosis and explore surgical methods for patients undergoing an initial operation and patients with recurrence.MethodsIn total, 10 patients with LTGDCs were admitted from April 2014 to December 2020.By reviewing the diagnosis and treatment of the first typical case, the characteristics of LTGDC under flexible laryngoscopy were summarized. According to these characteristic manifestations, a clinical diagnosis of LTGDC was made correctly in the other 9 patients. All 10 patients underwent preoperative CT of the neck and sagittal reconstruction and thyroid ultrasound.ResultsOf the 10 patients, the first 2 patients had recurrent LTGDCs after several operations and underwent Sistrunk surgery. The remaining 8 patients were newly diagnosed and underwent endoscopic radical resection with low-temperature coblation; of these patients, 7 had no recurrence, and 1 underwent Sistrunk surgery after developing short-term recurrence. All patients were followed up for 5 months to 6 years after the last operation and were without recurrence.ConclusionLTGDCs are easily misdiagnosed as epiglottic cysts in the clinic. A correct clinical diagnosis can be made based on the characteristics according to flexible laryngoscopy. To determine the relationship between the cyst and hyoid bone, CT was performed. The surgical method was chosen based on the relationship between the cyst and hyoid bone and history of recurrence.     

Endoscopic management of intralingual thyroglossal duct cysts: Case series and systematic review

ObjectiveTo discuss our institutional experience with endoscopic management of intralingual thyroglossal duct cyst (TGDC) and review cases in the published literature in a systematic review.MethodsPediatric patients with intralingual TGDC treated with endoscopic surgery at our institution from 2009-2019 were identified. Metrics from our case series were then compared to those in the literature in a systematic review to assess pooled outcomes of endoscopic or transoral management. Patient demographics, age of presentation, presenting symptomatology, size of cyst on imaging, type of surgery, and post-operative outcomes were assessed.ResultsWe identified 5 institutional cases of intralingual TGDC and 48 cases of intralingual TGDC described in the literature. The average age of presentation was 20.36 months. 69.8% (N=37) of patients presented with at least one respiratory symptom, 22.6% (N=12) presented with dysphagia, 9.4% (N=5) presented with an identified mass in the oropharynx, and 15.1% (N=8) had the cyst discovered as an incidental finding. Three patients required revision surgeries due to prior incomplete TGDC excisions and one patient experienced a recurrence >6 months after primary excision requiring a second procedure. Our data pooled with published case series in systematic review confirms that endoscopic or transoral management are excellent options for definitive management of intralingual TGDC.ConclusionsIntralingual TDGC is a potentially life-threatening variant of TGDC. Our results pooled with published series in a systematic review suggest that endoscopic or transoral management of intralingual TGDC are excellent minimally invasive treatments with a low risk of recurrence. Postoperative surveillance up to one year is recommended.     

Carcinoma in thyroglossal duct remnants

Two cases of carcinoma arising in thyroglossal duct remnants are reported to add to the previously documented 78 cases in the literature. This rare lesion, which occurs is less than 1% of thyroglossal duct abnormalities, pathologically and clinically is similar to primary tumors arising in the thyroid gland. Papillary adenocarcinomas constitute 75-85% of all cases reported and most are confined to the duct remnant itself with metastasis being infrequently recorded. Therapy consists of wide excision of the tumor-bearing tissue (Sistrunk procedure) in those cases localized to the duct remnant itself. In instances where metastasis or additional lesions are detected in the thyroid gland, thyroid ablation and neck dissections are indicated. Additional modalities such as suppressive thyroid therapy, radioactive iodine, and external radiation have been employed. Distant metastasis is rare and the long-term prognosis is very favorable.     

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.     

Atypical thyroglossal duct anomalies

OBJECTIVE: Thyroglossal duct (TD) anomalies are generally considered to be a distinct clinical entity. However occasional cases do not conform to the standard picture and are complex. This study aimed to scrutinise consecutive cases of TD anomaly managed surgically over 7 years at a tertiary teaching hospital and analyse those with atypical features. METHODS: This is a retrospective study of 62 children managed for a clinical diagnosis of TD anomaly from 1998 to 2005. Their medical records were reviewed for clinical presentation, investigations, operative findings, histopathology, management and outcome. After a clinical diagnosis, they had individualized investigations (USG, MRI, radioiodine scan, FNA) prior to the Sistrunk operation. RESULTS: 5/62 cases had atypical features. 2/5 were adolescents with a short history while 3 were below 5 years of age with onset since infancy. 4/5 were females. 1/5 had a Sistrunk operation earlier, 2/5 had a redo surgery prior to cure. 3/5 had a grossly identifiable tract at surgery, one with a midline course and two deviating laterally to open at the left pharyngeal wall. The final histological diagnosis was a mixed thyroglossal-dermoid cyst (case 1), TD anomalies with aberrant pharyngeal communication (cases 2 and 3), isthmic thyroglossal 'cold' cyst (case 4), and a tuberculous cyst (case 5). Postoperatively, Cases 2 and 3 had wound infections that were managed conservatively while case 5 developed an incisional sinus that healed after a month of anti-tuberculous chemotherapy. Cases 1 and 4 had an uneventful recovery. At an average f/u of 2 years, all are asymptomatic and well. CONCLUSIONS: 5-10% of apparent TD anomalies may present with atypical clinicopathologic characteristics. Atypical cases and late presentations may warrant additional investigations to establish the diagnosis and tailor management.     

First-intention surgical treatment of thyroglossal duct cysts in children: apropos of 99 cases]

INTRODUCTION: Thyroglossal duct cyst (TGDcs) is the most common malformation of the neck. The risk of infection and malignant transformation impose its treatment. OBJECTIVES: The purpose of our study were: 1) to specify some points about the symptomatology and preoperative evaluation necessary for TGDcs diagnosis; 2) to analyse the factors who can explain an unsuccessful surgical treatment. PATIENTS AND METHODS: Our study is based on a retrospective review of cases and a review of the literature. From 1981 to 2000, 99 children with a mean age of five years were treated for a TGDcs with a surgical procedure in the Grenoble University Hospital. 3 excision and 96 Sistrunck's procedure were performed. In all cases a histological study was made. RESULTS: Ultrasonography was the most frequent preoperative evaluation. We have had 7 complications: 3 haematoma, 2 abscess and 2 desunited scar. 6 children have had recurrent disease. Among these 6 children, 3 have had an excision and 3 a Sistrunck's procedure. No case of malignant transformation was reported. CONCLUSION: Ultrasonography is the first preoperative evaluation to obtain before surgical treatment of a TGDcs. Sistrunck's procedure is the best surgical treatment with a value of recurrence from 1% to 10%. Areas of surgical failure included breaking of cyst during the dissection, inadequate hyo?d bone resection, an anatomical variation with many ductuli in the base of tongue, inadequate muscles of tongue resection.