What is a Thyroglossal Duct Cyst?

Thyroglossal duct cysts are benign structures detected in the midline of the neck; they are the most common congenital neck cysts.

Figure 1: Appearance of thyroglossal duct cyst detected in the neck midline

How Does a Thyroglossal Duct Cyst Form?

The thyroglossal duct (canal) is the canal that allows the development of the thyroid gland of the baby in the womb. This canal starts from the base of the tongue and extends to the midline of the neck where the thyroid gland is formed, allowing the necessary stem cells to migrate to the area where the thyroid gland will form, and the canal disappears on its own after the thyroid gland is formed. While the cell residues lining this canal should normally disappear after the thyroid gland has completed its formation, thyroglossal duct cyst disease occurs when they persist along the canal.

Figure 2: Physical examination and anatomical appearance of thyroglossal duct cyst detected in the neck midline

Who is Thyroglossal Duct Cyst Seen in?

Although this disease is usually seen in children and adolescents, it can rarely be seen in adults over the age of 20. The disease has similar incidence rates in women and men.

What are the Clinical Findings of Thyroglossal Duct Cyst?

If the cyst is not infected, that is, does not get infected or does not rupture and open to the outside of the neck, it does not show any symptoms other than a small swelling in the middle line of the neck. However, if it becomes infected, there may be redness, pain, growth in the mass and discharge from the mass. It can very rarely cause difficulty in swallowing and breathing. An important finding is that the mass moves with swallowing and tongue movement. Sometimes it can open to the outside without being infected, and in that case, there is a clear mucous fluid flow from it.

How is Thyroglossal Duct Cyst Diagnosed?

The basic criteria are history and physical examination. There are clinical complaints mentioned above in the history, sometimes there are recurrent infection attacks and clinical complaints that improve with antibiotics.

A general systemic examination is performed in the physical examination, a marble-sized midline mass is detected in the neck, especially when swallowing and sticking out the tongue. If it has had a lot of infection, it may not move. Then blood tests and neck ultrasonography are performed. Here, both the cyst and the thyroid gland are evaluated. If the thyroid tissue is not normal in the ultrasound, thyroid scintigraphy should be performed. There may be thyroid gland tissue inside the thyroglossal duct cyst, or even there may be no thyroid tissue in its normal location, but only inside the cyst. This may be the only thyroid tissue in the patient, and the patient may remain thyroidless after surgery.

What Can a Thyroglossal Duct Cyst Be Confused With?

It is usually not confused with a good history and physical examination, but the following diseases should still be kept in mind in the differential diagnosis: Dermoid cyst, Epidermoid cyst, Branchial cyst, Thyroid pyramidal lobe hyperplasia and cysts, Lipoma, Ectopic thyroid tissue, Lymphadenopathy, Sebaceous cysts, Hamartoma and Teratoma

What is the Treatment of Thyroglossal Duct Cyst?

If the thyroglossal duct cyst is infected, antibiotic treatment is started, surgical treatment can be done after the completion of infection treatment.

The cyst and its extension to the base of the tongue are removed with surgery. During the surgery, the middle part of the hyoid bone, one of the respiratory support bones, is also removed together with the cyst and the canal. It is the most important procedure performed to prevent the recurrence (recurrence) of the cyst. The removed part is sent for pathological examination.

What kind of damage is seen when Thyroglossal Duct Cyst is not operated on?

Frequent infection and cancer development in the cyst at an adult age are the most serious complications.

When is Thyroglossal Duct Cyst Operated?

The disease should preferably be removed surgically when diagnosed, before it becomes infected.

Is There a Treatment Method Other Than Surgery for Thyroglossal Cyst?

No, there is not.

What is Done Before Thyroglossal Cyst Surgery?

First of all, a good history should be taken and a general physical examination should be performed, and if there are other diseases, they should be treated first. Then, the family (mother and father) should be well informed about the process, that is, before the surgery, during the surgery and after. If the child is older, the child is also included in this. A number of tests are performed, these tests are not general and are determined according to the patient. And the patient is also seen by the anesthesiologist, the family and the child are informed about the anesthesia process to be experienced. The patient is fasted for 4 hours before the surgery.

What is the Recovery Process After Thyroglossal Cyst Surgery?

When the patient comes out of surgery, there may be a drain in the neck to control bleeding, which is usually removed 24 hours later. The patient is fed 2 hours after the surgery in accordance with the doctor and/or nurse's instructions.

The patient can usually go home 6-8 hours after the surgery, but may need to stay in bed for 1 night, this is decided by the doctor depending on the condition of the surgery.

After the surgery, the patient only takes painkillers according to the doctor's recommendations, there is no need to take additional medication. The patient is seen by the doctor 48-72 hours later, there is no need for dressings at this time, the stitches dissolve on their own and do not need to be removed. The patient continues his normal active life in accordance with the doctor's recommendations after the surgery.

Is a 2nd Surgery Necessary in Thyroglossal Cyst Surgeries?

If the surgery is performed properly, it usually does not recur.

What are the Risks of Thyroglossal Cyst Surgeries?

Since the patient will receive general anesthesia during the surgery, there may be anesthesia risks, and the relatives of the patient are informed about this by the anesthesiologist before the surgery.

In addition, there may be some surgical complications (such as wound infection, bleeding, thyroid gland damage, tracheal problems, hoarseness, which are rarely seen when the surgery is performed properly).

*** The information provided here and the content of the website are arranged for the purpose of informing visitors, especially families. No information should be considered as advice by visitors and should lead to any decision or action. The patient should definitely be examined by a pediatric surgeon on the subject, consulted with him and made a decision by consulting his/her personal information.