The thyroid gland begins its embryological development in the third gestation week, migrating from the cecum foramen in the tongue base to its definitive position in the inferior pre-tracheal neck. The thyroid gland remains in contact with the tongue base through a tract, the thyroglossal tract, till the end of the embryogenesis when it normally involutes and closes. If any portion of the duct persists, secretion of the epithelial lining can result in inflammation and thyroglossal duct cyst formation. It is the most common congenital cervical anomaly with 7% population prevalence, often occurring in pediatric patients.

The authors present a case of a 57-year-old caucasian male patient referred to our Department with an anterior cervical mass. The patient’s main complaint was aesthetics. He had no pain but reported that the mass had been slowly growing for eight years. Clinical examination confirmed a cystic, non-tender, moving with swallowing submental swelling with 6-7 cm of major diameter (Figure 1). He initially performed a neck ultrasound that revealed a thyroglossal duct cyst with 55 mm and then, a fine needle aspiration confirmed the diagnosis. To further delineate the lesion, a CT scan was performed. It showed a non-complicated cystic mass with 54 x 47 mm. We performed surgical excision of the cyst, tract and central part of hyoid bone (Sistrunk procedure) and sent the specimen for histopathological evaluation.

Persistence of non-obliterated thyroglossal duct culminates in the formation of a Thyroglossal Cyst. It can develop anywhere along the path of the thyroglossal duct, including within the hyoid bone, the tongue and the floor of the mouth. However, the subhyoid location has been reported as the most common in most studies [1-4].

Figure 1: Sistrunk Procedure.

Typically, the clinical presentation consists in the presence of a painless, mobile, non-tender midline neck mass near to the hyoid bone [1-3]. In some cases, patients report pain due to infection, dysphagia, globus sensation, and cough or airways obstruction [3]. The diagnosis is achieved by performing a careful evaluation of symptoms along with diagnostic testing. A full head and neck and oral examination should be performed. Ultrasound confirms the diagnose and it’s the ideal initial imaging of choice. The CT scan and MRI can be used to evaluate the Thyroglossal duct cyst and the presence of normal thyroid tissue [1]. The standard treatment for these patients is surgery. It is almost always recommended to prevent recurrent infections [2,3]. The simple excision of the duct cyst has high recurrence rates (45-55%) [2]. However, Sistrunk described a radical excision that is currently the standard care of this condition. It consists in the resection of the central third of the hyoid bone and a core of the tongue tissue. It should not be performed in the presence of acute infection [2-4]. Possible complications include laryngotracheal injury, hypoglossal nerve injury, wound infection (4%), seroma, hematoma, recurrence of the cyst (3-5%) and salivary fistula [4]. The patient had a post-operative period with no complications and resumed his normal life. There is no evidence of recurrence to the current date.

CT: Computed Tomography; MRI: Magnetic Resonance Imaging

1. Patigaroo SA, Dar NH, Jallu AS, Ahmad R. Thyroglossal Duct Cysts: A Clinicosurgical Experience. Indian J Otolaryngol Head Neck Surg. 2017; 69: 102-107.
2. Amos J, Shermetaro C. Thyroglossal Duct Cyst In: Stat Pearls. Treasure Island FL: Stat Pearls Publishing. 2019.
3. Moorthy NS, Arcot R. Thyroglossal duct cyst-more than just an embryological remnant. Indian J Surg. 2011; 73: 28-31.
4. El-Ayman YA, Naguib SM, Abdalla WM. Huge thyroglossal duct cyst in elderly patient: Case report. Int J Surg Case Rep. 2018; 51: 415-418.