What is a Thyroglossal Cyst?

Thyroglossal cyst is a fibrous cyst; it develops from a persistent Thyroglossal duct during the thyroid gland development. Thyroglossal cyst is an irregular mass or a lump in the neck which develops from remnant cells and tissues after the formation of the thyroid gland during developmental stages.

What are the Symptoms of a Thyroglossal Cyst?

The typical symptom of a thyroglossal duct cyst is the presence of a smooth lump or mass in the middle of your neck. The lump usually moves during swallowing or when you protrude your tongue.

The lump may not become visible until a few years or more after birth. In some cases, you may not notice a lump or know cyst's presence until you have an infection that causes swelling of the cyst.

Other common symptoms of a thyroglossal cyst include:

• Hoarseness of voice
• Difficulty in breathing and swallowing
• An opening may be in your neck near the cyst, where mucus drains out.
• Tenderness (pain when you touch the area of cyst)
• Redness of the skin around the region of the cyst

Redness and tenderness may be present only when your cyst gets infected.

How is Thyroglossal Cyst Diagnosed?

PHYSICAL EXAMINATION-
In Physical examination, your doctor will palpate your neck to find out Thyroglossal cyst's presence.

BLOOD TEST-
A blood test is performed to test the amount of Thyroid hormones in your blood and the functioning of the Thyroid gland.

Ultrasound-
An Ultrasound produces an image of the degree of mass and its surrounding tissue.

CT scan-
CT Scan uses a beam of X-rays to create a 3-D image of the tissues in your throat.

MRI scan-
MRI Scan uses a beam of radio waves and a magnetic field to generate images of the tissues in your throat.

FNAC-Fine Needle Aspiration Cytology-
In FNAC, your doctor inserts a needle into the cyst to aspirate cells; they can examine these aspirated cells to confirm the diagnosis.

Treatment of Thyroglossal Cyst?

MEDICATION- Antibiotics to treat an infection if present.

SISTRUNK SURGERY-
Your doctor will likely recommend surgery to remove the Thyroglossal cyst, especially if it's been infected or is causing difficulty in breathing or swallowing.

Sistrunk procedure-
In general, the Sistrunk procedure consists of three steps:

Step 1- Incision
Step 2-Resection of the Thyroglossal cyst and hyoid bone.
Step 3_Drainage and closure of cyst.

There are modifications of the Sistrunk procedure, including:

• Classic Sistrunkprocedure-

The classical procedure involves-

1. Excision of the central portion of the hyoid bone along with the entire Thyroglossal cyst
2. Removal of one-eighth inch diameter of tongue muscle superior to the hyoid bone.
3. Closure of the cut ends of the dissected hyoid bone and placement of a drain to drain the cyst's contents.

Modified Sistrunk procedure:
Modified Sistrunk procedure- the procedure of choice for both primary and recurrent cases.

1. Dissection is done through the base of the tongue but not through the mucosa.

Hyoid cartilage division-
In cases with incomplete ossification of the hyoid bone, the non-fused cartilage portion can be divided by monopolar Bovie electro-cauterization or scissors.

Sistrunk surgery procedure-

• The surgery will be performed under general anesthesia.
• The surgeon will make an incision in front of the neck to open the skin and muscles above the cyst.
• The surgeon will remove the cyst and surrounding tissue. (to avoid recurrence)
• The surgeon will remove a small piece of your hyoid bone, along with any remaining tissue of the thyroglossal duct.
• The surgeon will drain the cyst
• The surgeon will give sutures to close the muscles and tissues around the hyoid bone and operated areas.