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.
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
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.
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
<ul><li>Thyroglossal Cyst </li></ul><ul><li>Thyroglossal Cyst is a cystic swelling which develops from the thyroglossal duct. It is a type of tubolodermoid. </li></ul><ul><li>The Fate of Thyroglossal Duct </li></ul><ul><li>Lower part forms the isthmus and two lateral lobes of thyroid gland. </li></ul><ul><li>Part form foramen caecum to the thyroid isthmus Disappears. </li></ul><ul><li>Part from hyoid bone to the isthmus of thyroid gland may persist as a fibrous cord to form levator glandulae thyroidae. </li></ul>
Relation of thyroglossal Duct with the hyoid bone <ul><li>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. </li></ul><ul><li>A portion of the thyroglossal duct may remain unobliterated and accumulation of secretion may occur leading to formation of thyroglossal cyst. </li></ul><ul><li>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. </li></ul>
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.
Clinical Features <ul><li>Asymptomatic small mass in midline in front of neck </li></ul><ul><li>Infected: tenderness, swelling & redness </li></ul><ul><li>Fistula: Opening in skin with discharge of mucous from cyst </li></ul><ul><li>Difficulty in swallowing or breathing </li></ul>
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.
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.
<ul><li>Complications </li></ul><ul><ul><ul><ul><li>Recurrent Infection </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Fistula Formation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Rarely Papillary Carcinoma may develp in thyroglossal cyst. </li></ul></ul></ul></ul>