The thyroglossal duct cyst is a common congenital swelling in the neck that may cause bothersome symptoms or recurrent inflammation and accounts for about 70% of all congenital masses in the midline of the neck. The thyroglossal duct cyst becomes inflamed in about 20–40% of cases before diagnosis or resection.
What is a thyroglossal duct cyst?
It is a congenital cyst that appears in the center of the neck as a result of the failure of the lingual thyroglossal duct to disappear during fetal development. Often found in children or adolescents, it appears as a soft, mobile mass when the tongue is protruded. A lingual parathyroid cyst is not usually a cancerous tumor, but it can become infected or, rarely, develop into a cancerous tumor, so surgical removal is recommended to avoid recurring infections or complications.
Thyroglossal duct cyst symptoms
The main symptoms of thyroglossal duct cyst include the following:
- A lump or swelling in the center of the neck: An enlargement at the base of the posterior tongue caused by a hard mass in the center of the neckline that is soft and usually painless unless it becomes inflamed.
- Pain when swallowing or pain when moving the neck: One of the first and most obvious signs, this symptom is medically referred to as “dysphagia” and can manifest as pain or discomfort while swallowing or a feeling of something stuck in the throat.
- Movement of the mass with tongue movement: This is a characteristic clinical sign, as the mass moves upward when the tongue is removed, which helps differentiate it from other masses.
- Redness or warmth in the skin over the cyst: Indicates inflammation.
- Skin breakout with discharge in chronic inflammation
Why is it preferable to remove a thyroglossal duct cyst?
The main reason doctors recommend surgical removal of the thyroglossal duct cyst is that it often becomes infected and, in rare cases, the cyst can become cancerous. Surgery prevents recurring infections and reduces the risk of abscess formation or complications. The surgery is known as the Sistrunk Procedure and involves removing the cyst along with a portion of the hyoid bone.
Thyroglossal duct cyst surgery steps
Doctors often discover this type of cancer while treating other medical conditions, and if they suspect a cyst may be cancerous, they may use the following tests to confirm the initial diagnosis:
- Computerized tomography (CT) scan: This test uses a series of X-rays combined with a computer to create three-dimensional images of the pharynx.
- Magnetic resonance imaging (MRI): A painless test that uses a large magnet, radio waves, and a computer to produce clear, precise images of the pharynx.
The Sistrunk procedure involves the removal of the cyst under general anesthesia as a one-day surgery, along with the duct and its branches. The central portion of the hyoid bone is excised to ensure complete removal of the duct, ending with wound closure and drains when needed. This procedure was based on the anatomical and embryological understanding of the lingual thyroid duct cyst, which led to a significant improvement in outcomes. Using the Sistrunk procedure for lingual thyroid duct cyst, the recurrence rate drops from 50% to 4%. Relapse after this procedure is very unlikely today.
Tips after thyroglossal duct cyst removal surgery
The patient should rest for several days after the operation to ensure a successful recovery. The patient can resume their usual diet without any restrictions, many patients may feel pain or stiffness in the throat during the first two days, and prefer to eat soft foods during this period, light to moderate activities are allowed according to tolerance, and the patient can move their head left and right and look up and down without excessive concern about stitches while avoiding heavy lifting, straining or strenuous exercise for at least one week after surgery.
Pain and stiffness in the neck are expected, and the doctor may prescribe a narcotic analgesic (Narcotic) that can be used as needed in cases of severe pain. Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can be used to relieve mild to moderate pain, with attention to the fact that narcotic analgesics may cause constipation. Contact your doctor if there is redness, increased swelling, or increased pain at the surgery site. The patient can shower normally, and the wound can be moistened.
With the development of microsurgery, the treatment of thyroglossal duct cyst has become safe and quick. It is a small cyst in the neck that may seem harmless but may cause issues later on, so don’t neglect to have it checked, as the surgical treatment of a thyroglossal duct cyst is simple and effective.
Sources:
- Children’s Hospital of Philadelphia. (n.d.). Thyroglossal Duct Cyst
- Kumar, L. K. S., Kurien, N. M., Jacob, M. M., Menon, P. V., & Khalam, S. A. (2015). Lingual thyroid. Annals of Maxillofacial Surgery
