A thyroglossal duct cyst is a neck mass that develops from leftover tissue from when the thyroid gland forms during embryonic development. It is most common in preschool-aged children and adolescents. Diagnostic tests include physical examination, ultrasound, and fine needle aspiration to evaluate the mass and rule out thyroid abnormalities. Treatment involves antibiotics if infected or surgical removal (Sistrunk procedure) of the entire cyst and tract to prevent recurrence, which is performed under general anesthesia as an outpatient procedure. Complications can include infection or rare chance of malignancy.

1. THYROGLOSSAL DUCT CYST

2. DEFINITION
 A Thyroglossal duct cyst is a neck mass or lump that
develops from cells and tissues remaining after the
formation of the thyroid gland during embryonic
development. They are typically located in the midline
of the neck

3. INCIDENCE
 Thyroglossal duct cysts account for 70% of all
congenital neck anomalies It is most commonly
diagnosed in preschool-aged children or during mid-
adolescence

4. LOCATION
The cysts can occur anywhere along the course of the
thyroglossal duct.
 Suprahyoid: 20-25% (less common in adults ~5%)
 At the level of hyoid bone: 15-50%
 Infrahyoid: 25-65%
 Typically, they are located in the midline (~70%) with
those off-midline characteristically tucked next to
the thyroid cartilage. Almost all thyroglossal duct
cysts are located within 2 cm of the midline, with
more inferior lesions tending to be off midline.

5. PATHOPHYSIOLOGY
 During embryonic development the thyroid gland
begins at the base of the tongue and moves down the
neck through a canal called the thyroglossal duct.
 The duct normally disappears once the thyroid reaches
its final position in the neck.
 Sometimes, portions of the duct remain leaving
cavities or pockets called cysts.
 These cysts fills with fluid or mucus
 Enlargement of the cyst due to infection
 Difficulty in swallowing or obstruction of breathing
passages.

6. SIGNS AND SYMPTOMS
 A small, soft, round mass in the center front of the
neck
 Tenderness, redness, and swelling of the mass, if
infected
 A small opening in the skin near the mass, with
drainage of mucus from the cyst
 Difficulty swallowing or breathing

7. DIAGNOSTIC EVALUATIONS
 History collection
 Physical examination:-
 The mass typically moves upward when the tongue is
extended and with swallowing since the thyroglossal duct
often connects at the base of the tongue.
 Blood tests:- These tests assess thyroid function.
 Ultrasound examination. To create images of blood
vessels, tissues, and organs to evaluate the mass and
surrounding tissues.
 Thyroid scans. To reveal any physical abnormalities of
the thyroid.
 Fine needle aspiration. A procedure that removes cells
from the cyst for diagnosis.

8. TREATMENT
 Specific treatment of a thyroglossal duct cyst will be
determined by the doctor based on:
 Child's age, overall health, and medical history
 Extent of the condition
 Child's tolerance for specific medications, procedures,
or therapies
 Expectations for the course of the condition
 Opinion or preference of the parents or the guardian of
the child

9.  Treatment may include:
 Antibiotic medication for treating the infection
 Sistrunk procedure:-
 The surgical procedure to excise a thyroglossal duct cyst
is called the Sistrunk procedure and is performed under
general anesthesia. The procedure is usually a day
surgery, meaning that your child will be able to go home
the same day as the procedure.

10.  A small incision is made over the cyst. The cyst and the
entire tract are removed, as well as the middle portion of
the hyoid bone, a small horseshoe-shaped bone that is
found in the neck below the chin. It is important that the
cyst and the attached tract are completely removed. If a
portion is left, the cyst has a higher likelihood of
recurrence, or coming back.

11.  Any tissue that is removed will be sent to the pathology
lab to confirm the diagnosis. The incision will be closed
with dissolvable sutures with either DERMABOND
(skin glue) or steri-strips on the skin.
 DERMABOND is a sterile, liquid adhesive that will
hold the edges of the wound together and act as a
waterproof dressing. It usually stays in place for 5-10
days before it starts to fall off. It should not be picked,
peeled or rubbed as this can cause wound to open before
it is healed.

12.  Once it sets, the adhesive can get wet (as in a shower)
the same day as the procedure, but should not routinely
be submerged under water (as in swimming) for 5-10
days. Do not apply any ointments such as Vaseline or
Neosporin to the incision while the DERMABOND is
in place.

13. COMPLICATIONS
 Infection
 Chance of malignancy