Thyroglossal duct cyst: Personal experience and literature review
Introduction
Neck masses are common findings at all ages and the differential diagnosis includes a wide range of pathologies. Among them, thyroglossal duct cysts (TDCs) are the most common congenital anomaly of the neck in childhood [1], representing more than 75% of congenital midline neck masses [2]. Although TDCs often occur in pediatric patients, at least half are diagnosed in the second decade of life and they can also present later in adulthood [3]. TDCs originate from persistent epithelial remnants of the thyroglossal duct [TD, or thyroglossal tract (TT)] that are present during the descent of the thyroid gland from the foramen cecum to its final position in the anterior neck. Although TDCs can be found anywhere along the TD, the majority of them occur in the midline of the neck close to the hyoid bone.
Successful treatment requires an understanding of the embryology and anatomy of the tongue, the thyroid gland and the hyoid bone [4], [5], [6]. Although the Sistrunk's procedure is the standard treatment for TDCs in many institutions, their management can still be a source of controversy in some instances.
Our experience and a critical literature review regarding embryology, anatomy, nomenclature, epidemiology, etiology, clinical features, preoperative evaluation, pathology, differential diagnosis, association between TDCs and neoplasms, treatment and complications of TDCs are presented.
Section snippets
Case reports
This retrospective study includes 14 patients (5 males and 9 females) with a preoperative diagnosis of TDC (see Table 1), all evaluated and treated at the ENT Clinic of the University of Udine and at the Otolaryngology Section of the “Città di Udine” Clinic between April 2000 and May 2007. The average patient age at diagnosis was 36.2 years (range: 5–71 years). The TDCs were located in the suprahyoid portion of the TD in 3 cases and in the thyrohyoid portion in 11 cases. In 10 patients the
Embryology
The embryogenesis of the tongue, thyroid gland and hyoid bone is key to understanding the anatomical features of TDCs. The development of the tongue starts during the 4th week of embryonic life involving the 3 cranial branchial arches. The 1st branchial arch gives origin to the lingual swelling and the tuberculum impar later to constitute the anterior two thirds of the tongue. The ventral portions of the 2nd and 3rd branchial arches, including the anterior half of the copula, merge into the
Conclusions
TDC may manifest at any age with clinical features that usually guide the physician to a correct diagnosis. Imaging, in particular US, may complete the routine preoperative evaluation. The surgical procedure, or some modification of the procedure, reported by Sistrunk in 1920 is considered the treatment of choice for the complete removal of TTRs. In the original description, the Sistrunk's operation entailed removal of the TDC in continuity with the mid-portion of the hyoid bone and with a core
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