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.     

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.     

Lingual thyroglossal duct cysts--a review

Objectives

Lingual thyroglossal duct cysts (TGDC) are rare and liable to be missed in a cursory clinical examination. This study aimed to report the details of lingual TGDC from the authors’ series and review existing literature on the entity.

Methods

A 12 year retrospective survey of all cases of thyroglossal duct anomalies managed at a tertiary teaching hospital was conducted to identify those with lingual TGDC. Their clinical presentation, investigations, diagnosis and management were analysed. Case series from anecdotal published English literature were critically reviewed with particular regard to diagnosis and management.

Results

Of 78 cases of thyroglossal duct anomalies, 3 were lingual TGDC. All were females. One neonate presented with feeding difficulty and was clinically misdiagnosed as a ranula. The two older children presented with a cyst at the foramen caecum. The varied imaging and diagnostic dilemma are presented. The older children had cysts abutting the hyoid and were managed with transoral excision and a Sistrunk procedure; the neonate was managed with transoral excision only. This report also reviews the sparse literature and discusses specific issues in their treatment. The differential diagnoses encompass a wide array of developmental and neoplastic entities. Specific anatomic imaging with USG/CT/MRI and functional evaluation with radionuclide thyroid scan are essential investigative modalities. Besides a classical Sistrunk procedure and simple transoral excision, newer less invasive treatment options including marsupialisation and alcohol ablation have been reported.

Conclusions

In conclusion, the diagnosis and management of lingual TGDC needs to be individualised depending on their presentation and anatomic location. The Sistrunk's procedure is ideal for those in close proximity to the hyoid; however complete cyst excision would suffice in the rest.     

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     

甲状舌管癌的临床诊治并文献复习（附2例报告）

目的通过对甲状舌管癌患者的诊断和治疗,并复习相关文献,总结该病的临床特征和准确制定合理的治疗方案。方法报道2例甲状舌管癌患者的诊治过程,影像学特点及治疗方法。结果2例患者术前均被误诊为甲状舌管囊肿,常规行Sistrunk手术,术后病检1例为甲状舌管乳头状癌,另1例为甲状腺乳头状癌,结合术中所见最后诊断为甲状腺舌管乳头状癌,2例术后复查甲状腺功能均正常,复查甲状腺超声未见明显恶性肿瘤特征,均未行甲状腺手术治疗,1例未做任何其他补充治疗,随访8年无局部复发和转移,另1例行甲状腺素抑制治疗随访1年无复发。结论甲状腺舌管癌临床罕见,术前易误诊为甲状舌管囊肿,术前超声及增强CT有助于诊断,需病理确诊,手术方案的制定需综合考虑,病理分型决定其预后。     

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.     

Outcome of thyroglossal duct cyst excision is independent of presenting age or symptomatology

BACKGROUND: Thyroglossal duct cysts (TGDCs) are the most common form of congenital neck cyst, accounting for up to 70% of such lesions. There has been no consensus on which factors predict outcome of thyroglossal duct cyst excision. The objective of the current study is to evaluate the relevance of symptomatology and age at presentation with outcome of TGDCs. METHODS: Retrospective review of patients with TGDC at a tertiary care children's hospital. Data collected included patient's age, gender, clinical presentation, presence or absence of preoperative infection, imaging modality, type of procedure performed, size and location of the lesion, postoperative infection, complications, and recurrence of disease. RESULTS: Twenty-nine patients were identified (59% female, 41% male). Age of presentation was bimodal and ranged from 18 months to 14 years. The most common presenting symptom was the presence of an asymptomatic midline neck mass (76%). A history of preoperative TGDC infection was present in 22% of patients /=5 years of age. Recurrence rate after the Sistrunk procedure was 3.4%. CONCLUSIONS: The finding of a midline neck mass is the most common presentation of TGDCs in toddlers, whereas infection is the most common presenting symptoms in school-aged children. The incidence of preoperative infection was 41% in our series, much higher than previously reported. Independent of presenting age and symptomatology, recurrence of TGDC remains low when the Sistrunk procedure is employed.     

Total persistence of thyroglossal duct with direct communication between cyst and foramen caecum

During embryonic development the thyroid gland migrates through the thyroglossal duct from the pharyngeal endoderm to the anterior cervical region. The final step in this process is the total obliteration of the thyroglossal duct. A case is presented of a patient with a thyroglossal cyst together with a complete failure of the obliteration of the duct, which caused regurgitations of mucopurulent material after the expression of the cyst. This indicates a complete failure of the obliterative process. To the best of our knowledge, this phenomenon has not been described previously in the literature.     

Lingual thyroglossal duct cyst in newborns: previously misdiagnosed as laryngomalacia

OBJECTIVE: To distinguish lingual thyroglossal duct cyst (LTDC) from laryngomalacia in newborn. METHODS: The clinical data of five newborns who were diagnosed as LTDC were retrospectively analyzed. RESULTS: Inspiratory stridor with chest wall retraction was cardinal symptom of newborn with LTDC. A slightly gray and round cyst with smooth surface at the base of the tongue was found with laryngoscopy. In computed tomography examination of larynx, a well-circumscribed lesion with low intensity was detected at the base of the tongue protruding into the air passage. Pathological examination demonstrated the cyst wall was composed of tabular and columnar epithelium. CONCLUSIONS: LTDC is a common disease in newborns, which is similar with laryngomalacia. For neonate suspected of LTDC, laryngoscopy examination should be taken first, while laryngeal CT scan is an important diagnosis basis to be reg. Cyst puncture can ameliorate the symptoms of LTDC, while surgical removal serves as a radical cure for LTDC.     

颈外径路Sistrunk手术治疗成人复发性舌甲状舌管囊肿的临床分析

目的 探讨成人复发性舌甲状舌管囊肿（LTGDC）的临床特点、误诊原因及手术治疗。方法 回顾性分析2018年1月—2021年3月收治的6例反复复发的成年LTGDC患者,术前行甲状腺B超提示甲状腺位置并排除异位甲状腺,颈部CT检查明确肿物大小、部位及与舌骨的关系,喉咽部MRI明确肿物性质。手术均采用颈外径路Sistrunk手术。结果 6例患者曾误诊为会厌囊肿4例,舌根囊肿2例,均已行囊肿切除术,复发时间3周至1年。所有患者行颈外径路Sistrunk手术完整切除甲状舌管囊肿及瘘管,术后病理确诊为甲状舌管囊肿。术后随访1年以上无复发。结论 复发性舌根部或会厌间隙的囊性肿物应考虑LTGDC的可能性。所有患者术前均应行喉镜检查和颈部影像学检查以了解囊肿的形态、位置及其和舌骨的关系来选择手术方式。对于成人复发性LTGDC,Sistrunk手术可彻底切除囊肿减少复发。     

甲状舌管囊肿术后嗓音分析

目的探讨甲状舌管囊肿(TDC)患者手术前后的嗓音变化特点。方法选取2018年1月—2019年12月行TDC切除术的患者49例为研究对象,其中男24例,女25例,年龄为22~65岁,平均年龄为(41.55±11.78) 岁。对患者术前,术后1周及术后6个月分别行嗓音障碍指数（VHI）和GRBAS的主观评估、嗓音声学分析的客观检测以及频闪喉镜检查,比较手术前后的评估结果。结果①VHI的评估：女性患者的情感（E）评分在术后1周较术前显著性差异（P<0.05）,术后6个月与术前差异不明显,而其功能（F）和生理（P）评分较术前无明显差异;男性患者手术前后的VHI各评分均无显著性差异;②GRBAS的评估：女性患者的气息度（B）和无力度（A）评分在术后1周较术前差异显著（P<0.05）,术后6个月同术前差异不大,而其总分（G）,粗糙度（R）和紧张度（S）评分无显著性差异;男性患者手术前后的GRBAS各评分均无显著性差异;③嗓音声学分析：男性及女性患者的基频（F0）和最长发声时间（MPT）在术后1周均较术前差异显著（P<0.05）,术后6个月同术前差异不明显;而其基频微扰（jitter）和振幅微扰（shimmer）无显著性差异。结论TDC患者手术后会出现嗓音评估指标的一过性改变,及早行嗓音评估、发音训练或心理干预,有利于患者的嗓音康复。     

“Extended” Sistrunk procedure in the treatment of recurrent thyroglossal duct cysts: A 10-year experience

Objective

We report a 10-year experience of children with recurrent thyroglossal duct cysts (TGDCs) who have been treated using the “extended” Sistrunk procedure.

Methods

We performed a retrospective review of TGDC surgery from 2004 to 2013. Sistrunk operation was the procedure of choice in all patients. Seven children had TGDC recurrence. All of them underwent “extended” Sistrunk procedure. Follow up ranged from 6 months to 8 years.

Results

There were no gender differences, all recurrences presented within 12 months follow-up in the same location of the primary cyst. Five out of 7 (71%) patients have been treated for preoperative and 2/7 (29%) for postoperative infection at the time of primary surgery. Pathological examination of the surgical specimens showed a single tract in 2 children (29%) and multiple tracts in 5 (71%). We did not observe postoperative complications or further recurrences.

Conclusion

Our experience suggest that recurrent TGDCs are equally common in both sexes, develop in the same location of the primary cyst and recur more commonly after perioperative infections. The “extended” Sistrunk procedure is highly effective and safe in treating recurrent TGDCs also if multiple duct tracts are detected.