This document discusses the case of a 14-year neck swelling in a patient, found to be a thyroglossal cyst extending into the larynx. Examination found a mobile neck mass moving with swallowing and tongue protrusion. Imaging showed a cystic mass in the supraglottis extending to the vallecula. The patient underwent a Sistrunk operation to remove the thyroglossal cyst, and pathology confirmed it was a thyroglossal cyst that had extended into the larynx. Thyroglossal cysts can rarely extend into the larynx, so this must be considered in diagnostic evaluations of midline neck masses.

1. THE EMBRYOLOGICAL REMNANTS

2. PERSISTANT REMNANTS OF BRANCHIAL
APPARATUS & THYROGLOSSAL DUCT
• First branchial arch fistula –
cervico aural
• Second branchial arch fistula
• Third and fourth branchial
arch abnormalities
• Disorders of thyroglossal duct

4. DESTINATION
• A MIDLINE LUMP’S EN-ROUTE

5. A MIDLINE LUMP’S DISCRETE
FORTUNE
DR. AJAY MANICKAM
JUNIOR RESIDENT
DEPARTMENT OF OTOLARYNGOLOGY
RG KAR MEDICAL COLLEGE

7. CASE HISTORY
With C/O
 Swelling in the front of neck for the past 14 yrs
 Foreign body sensation in throat for the past 1
month

8. NO HISTORY

11. Examination in opd
• The mass in the neck was
around 5 x 4 cm
• It was mobile, non tender,
insidious in onset and
gradually progressive
• Moves with deglutition
• Moves with protrusion of
tongue

13. EXAMINATION OF ORAL CAVITY

14. INDIRECT LARYNGOSCOPY
EXAMINATION
• Mass in the supraglottis,
extending to vallecula,
glottic chink was narrow,
bilateral arytenoids, AE
folds, Vocal folds were
mobile
• NO PALPABLE NECK
NODES

15. DIAGNOSTIC DILEMMA
• 1. Laryngeal carcinoma
• 2. Sebaceous cyst
• 3. Dermoid cyst
• 4. Lipoma
• 5. Branchial Cleft cyst
• 6. Metastatic Lymphnode
• 7. Ectopic thyroid

16. CLINCAL EXAMINATION
• CLASSICAL APPEARANNCE
• MOVEMENT
• POSITION
• HISTORY NEARLY 14 YEARS
• AGE
• H/O SMOKING, ALCOHOLISM

17. PLAN
• ADMISSION
• INVESTIGATION

18. INVESTIGATIONS
• ULTRA SONOGRPHY OF NECK
Solid SOL with echogenic matter, measuring
4x3cm, anterior and superior to the thyroid
gland
• FNAC
Thyroglossal cyst

19. CT SCAN OF NECK
• Heterogeneously enhancing necrotic,mass lesion with
• Superior extent to the left supraglottic region upto valeculla
• Lateral
extension into
left paraglottic
Space
• Anteriorly it extended within the subcutaneous tissue with
erosion of left thyroid lamina

20. MANAGEMENT

21. MANAGEMENT
• Sistrunk operation

22. TRACHEOSTOMY

23. Post operative management

24. DAY 0 –DAY 7

25. HISTOPATHOLOGICAL REPORT

26. THYROGLOSSAL CYST

27. DISCUSSION
1. INFRA HYOID
2. SUPRA HYOID
3. INTRA LINGUAL
4. SUPRA STERNAL
Laryngeal extension

28. THYROGLOSSAL CYST
ENROUTE LARYNX

29. • Clinical examination
• Radiological guidance in
cases with diagnostic
dilemma
• Intra laryngeal extension
though rare to be kept in
mind

30. THANK YOU