Thyroglossal duct cyst: Personal experience and literature review

Abstract

The thyroglossal duct cyst [TDC, or thyroglossal tract remnant (TTR)] is a well recognized developmental abnormality which arises in some 7% of the population. As a consequence, it represents the most common type of developmental cyst encountered in the neck region. It typically presents as a mobile, painless mass in the anterior midline of the neck, usually in close proximity to the hyoid bone. Less often, TDCs may present with signs and symptoms of secondary infection, or with evidence of a fistula. While TDCs are most often diagnosed in the pediatric age group, a substantial minority of patients with TDCs are over 20 years of age at the time of diagnosis. The standard surgical approach to TDC, encompassing removal of the mid-portion of the hyoid bone in continuity with the TDC and excision of a core of tissue between the hyoid bone and the foramen cecum, dates back to the late 19th and early 20th centuries and is often referred to as Sistrunk's operation. Malignancy is rarely encountered in TDCs; when such rare tumors do develop (in the order of 1% or so of patients with TDCs), they usually take the form of either papillary carcinoma of thyroid origin, or squamous carcinoma.

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.