2. Name Naveen
Age 10 Years
Sex Male
Chief Complaints Swelling in the midline, in front of the
upper part of neck for last 3 years
History of Prestning Swelling – Insidious onset.
Illness Progression – Gradually increasing in size
No History of Pain over the swelling.
No History of any discharge from
swelling.
3. Examination Site - In the Midline of neck, in front
of Thyroid Cartilage
Size - 2cm in diameter
Shape – Round in Shape
Surface – Smooth
Margins are Rounded, free from underlying
Skin and Structures
Fluctuation Positive
Trans illumination Negative
Swelling Moves up and down with
deglutition and also moves up with
protrusion of tongue.
Examination of Regional - Lymph Nodes Not Enlarged
Lymph Nodes
4. Examination of the - No Ectopic Thyroid Tissue Present
Base of the tongue
Summary of the Case
This ten year old Child Presented with swelling in the midline
in front of the upper part of the neck for the last three years which is
gradually increasing in size, there is no pain over the swelling. There is no
history of any discharge from the swelling.
Swelling Moves up on
Protrusion of the
thongue.
5. Diagnosis
This is a case of thyroglossal syst situated in the prelaryngeal
region
Differential Diagnosis
Differential diagnosis: These cysts should be
differentiated from
1. Dermoid cyst - cheesy secretion
2. Infected lymph node (Delphian) - purulent
secretion
3. Lipoma - slippery edges
4. Sebaceous cyst - doughy feel
5. Thyroid isthmus tumour
6. Thyroglossal
CysT
Thyroglossal Cyst is a cystic swelling
which develops from the thyroglossal
duct. It is a type of tubolodermoid.
The Fate of Thyroglossal
Duct
•Lower part forms the isthmus and two
lateral lobes of thyroid gland.
• Part form foramen caecum to the
thyroid isthmus Disappears.
• Part from hyoid bone to the isthmus of
thyroid gland may persist as a fibrous
cord to form levator glandulae thyroidae.
7. Relation of thyroglossal Duct with the hyoid bone
• A long the course of the duct ectopic thyroid tissue
may develop in deferent sites – lingual thyroid, ectopic
thyroid tissue in sub mental and sub hyoid or
prelaryngeal region.
• A portion of the thyroglossal duct may remain
unobliterated and accumulation of secretion may occur
leading to formation of thyroglossal cyst.
The thyroglossal Duct descend usually in front of the
hyoid bone. The duct however may form a retro hyoid
loop and then descends downwards. Rarely the duct may
pass through the hyoid bone.
9. Pathology
The thyroglossal cyst in lined by columnar or cuboidal epithelium.
The cyst epithelium is surrounded by a rim of lymphoid tissue.
The cyst contains thick jelly like fluid which may contain Cholestrol
crystals.
10. Clinical Features
Asymptomatic small mass in midline in front of neck
Infected: tenderness, swelling & redness
Fistula: Opening in skin with discharge of mucous from cyst
Difficulty in swallowing or breathing
11. Investigations
I would like to do a 131I Scan of thyroid gland to
exclude any ectopic thyroid tissue in the swelling.
In case ectopic thyroid tissue this may be this may
be the only functioning thyroid tissue and no other
tissue will be seen.
Ultra sonography
Used to Determine the nature of thyroid nodule.
Ability to determine nodule has a cystic component.
Purely cystic masses are always be benign.
Mixed – Solid Cystic components
- Malignant.
Can also help FNA when Thyroid Nodules are small and difficult to
palpate.
12. Operation
I will do a Sistrunk operation. This is a operation involves complete excision of
cyst along with thyroglossall tract.
The operation is done under local anesthesia. The neck is extended by placing a sand
bag in between the shoulder blades and head rests on a heads ring. An elliptical incisions
made around the cyst and the cyst is dissected all around. The thyroglossal duct
Attached to the cyst is dissected upwards. The body of hyoid bone is excised. The
excision of the body of the hyoid bone helps in excision of any retro hyoid part of the
thyroglossal tract and also complete excision of the thyroglossal tract up to the foramen
caecum.
