THYROGLOSSAL DUCT CYST
DEFINTION
Cystic swelling arising from embryological remnant of thyroglossal duct.
It is regarded as tubulodermoid.
Thyroglossal duct cysts are the most common congenital midline neck cyst (account for 70% of all
congenital neck anomalies, and are the second most common benign neck mass, after
lymphadenopathy).
EMRYOLOGY
Initially thyroid gland appears as proliferation of Endodermal tissue in the floor of the pharynx
between Tuberculum impar and Hypobranchial eminence (this area is the later foramen caecum)
(17th day of gestation).
Cells of thyroid gland descend into the mesoderm into the hypopharyngeal eminence (later pharynx)
as cords of cells. During this descent thyroid tissue retains its communication with foramen caecum.
This communication is known as thyroglossal duct. It reaches its final position in the neck by the 7th
week of gestation. The duct usually disappears by the 10th week of gestation.
Persistence of this can lead to cystic degeneration forming thyroglossal cyst.
PATH OF DUCT
Foramen caecum via Genioglossus hyoid (usually behind but can be in front or in the matter of
hyoid) upper border of thyroid cartilage.
Since the hyoid bone develops later and joins from lateral to medial, the thyroglossal duct may get
trapped in the substance of the body of hyoid bone, resulting in the tract running inside the body of
the bone.
Tongue and foramen cecum forms after the complete descent of the thyroglossal duct so rarely a tract
could be found at the level of foramen cecum.
This tract has been attributed to the persistence of lingual duct, which represents the point of union
between the anterior and posterior components of the tongue.
THEORIES OF THYROGLOSSAL CYST
CYSTIC DEGENERATION
This theory suggests that recurrent throat infections could possibly stimulate the epithelial remnants
of the tract causing it to undergo cystic degeneration.
RETENTION PHENOMENON
This theory suggests a block in the thyroglossal duct (mainly at foramen caecum) could cause the cyst
to expand because of retained secretions (as duct contains serous mucinous glands and continued
secretions may lead to expansion)
FATE OF DUCT
Completely atrophies except in lower part where it forms Thyroid isthmus and pyramidal lobe (if
present)
Disappears upto hyoid, rest forming Levator Glandulae Thyroidae.
Non descent leads to lingual thyroid.
May give rise to thyroglossal cyst.
SITES WHERE THYROGLOSSAL CYST MAY OCCUR
Infrahyoid (commonest)
Suprahyoid
Hyoid
Rarest at tongue.
DIAGNOSTIC CRITERIA
Age – Children usually but can occur at any age
Sex – More commonly in females
Midline cystic swelling, smooth surface, can be moved sideways but not up and down
Moves with deglutition as attached to hyoid bone by fibrous tissue
Moves on protrusion of tongue
Tansillumination usually negative
Painless and non tender (if not infected)
HISTOPATHOLOGY
Lining of cyst wall – Columnar usually can be cuboidal or squamous epithelium too surrounded by a
shell of lymphoid tissue. It may contain thyroid tissue.
Contents – Transparent thick jelly like fluid, cholesterol crystals and occasionally clotted blood.
DIFFERENTIAL DIAGNOSIS
1. Dermoid cyst – cheesy secretion
2. Infected lymph node – Purulent secretion
3. Lipoma – slippery edges
4. Sebaceous cyst – doughy feel
5. Hypertrophic pyramidal lobe of thyroid
TREATMENT
SISTRUNK OPERATION
Involves exposing the whole cyst along with its tract. The anterior portion of the body of the hyoid
bone should be included in the dissection to prevent recurrence.
It was Wenglowski who suggested that along with the body of hyoid bone a core of tissue between
the hyoid bone and the tongue should also be removed to reduce the incidence of recurrence.
A horizontal skin crease incision is made over the convexity of the cyst.
