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.