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Clinical Summary

A thyroglossal duct cyst arises from the incomplete obliteration of the thyroglossal duct during fetal development. It usually presents as a painless, midline, anterior neck mass that moves with swallowing and protrusion of the tongue. It may occur anywhere from the base of the tongue to the sternal notch but is usually located at or below the hyoid bone adjacent to the thyrohyoid membrane. These cysts may rapidly enlarge if infected, which often occurs in association with upper respiratory symptoms.

Management and Disposition

The diagnosis of this lesion is suggested by history and physical examination. Antibiotics are indicated if the lesion has rapidly enlarged due to infection. Common pathogens include H influenzae, S aureus, and Staphylococcus epidermidis. Treatment involves complete surgical excision of the cyst and tract (Sistrunk procedure) following resolution of any associated infection. Referral to an otolaryngologist is appropriate. The differential diagnosis includes a dermoid cyst.

FIGURE 14.85

Thyroglossal Duct Cyst. A midline mass is seen in thyroglossal duct cyst. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 14.86

Thyroglossal Duct Cyst. CT of the neck showing anterior thyroglossal duct cyst. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 14.87

Thyroglossal Duct Cyst. Lateral view of thyroglossal duct cyst. (Photo contributor: Lawrence B. Stack, MD.)

Pearls

  1. A thyroglossal duct cyst is the most frequent congenital head and neck lesion in children.

  2. In approximately 1% of patients with this lesion, the only functional thyroid tissue is located within the cyst. Therefore, patients should be screened by history for symptoms of hypothyroidism. If symptoms are present, a serum thyroid-stimulating hormone should be sent, and ultrasound of the midline neck should be considered prior to surgical removal.

  3. The cyst typically moves up with protrusion of the tongue or with swallowing due to its relationship with the hyoid bone and larynx.

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