Thryoglossal Cyst

Thyroglossal cyst

A thyroglossal cyst is a mass of the neck that occurs as a result of the remnants of the thyroglossal duct - a pathway in the embryo through which the thyroid gland travels between the tongue and the neck. The most prevalent midline swelling of the neck is congenital.

Causes of Thyroglossal Cyst

• The thyroglossal duct not totally disappearing during fetal development.
• The secretions in the remnant tract build up.
• The remnant duct is infected to form cysts.

Indications for Surgery

• Cystic splenosis or cystic enlargement.
• Recurrent infections
• Cosmesis (concerning appearance)
• The suspicion of malignancy (uncommon -approximately 1 per cent)

Thyroglossal duct cyst symptoms

The typical symptoms of a Thyroglossal Duct Cyst (TGDC) are as given in an easily readable and a medically factual list:

Midline Neck Swelling

• Soft, smooth, round mass
• Midline, typically below the hyoid bone.
• Majority of characteristic features.

Swallowing and Tongue protrusion moves

• Since the cyst is connected to the tongue through the left over duct.
• An extremely significant diagnostic symptom.

Painless Lump (Initially)

• In most cases painless unless infected.
• May gradually grow in size month by month or year after year.

Pain/Tenderness Infected

• It is prone to infection since it is related with the upper airway.
• This may result in redness, warmth, swelling and pain.

Difficulty Swallowing (Dysphagia)

• ccurs in larger cysts
• Effects of pressure on the structures around it.

Breathing Problems (Dyspnea)

• Uncommon but may occur with huge cysts.

Release of a Sinus or Opening

• In case the cyst bursts or becomes a fistula.
• Mucus-like or pus discharge

Recurrent Neck Infections

• Recurrent swelling, erythema and pains.
• Implicates a lacerated or partly torn cyst.

Cosmetic Concerns

• Dull, painless swelling of the front of neck.
• Frequently the motive behind the evaluation of the patient.

Thyroglossal cyst treatment

Surgical excision is the good cure of thyroglossal duct cyst (TGDC). It cannot be cured by medications.

Sistrunk Procedure (Gold Standard Treatment)

• Sistrunk procedure is the best surgery used to treat TGDC.

What it Includes?

• Removal of the cyst
• Removal of the whole tract of thyroglossal ducts.
• Abrasion of the midpoint of the hyid bone.
• The excision up till the bottom of the tongue at which duct originates.

Why Sistrunk?

• The thyroglossal duct goes through the hyoid bone.
• Once such a segment is not removed, then recurrence is likely.
• Compared to simple excision (45-50), Sistrunk procedure lowers the recurrence rate to less than 5%.

When Surgery is Needed?

Surgery is recommended if:

• Lump (should be there without any symptoms)
• Recurrent infections
• Cysts get painful or swollen.
• Cosmetic concerns
• Fistula or discharge
• Concern malignancy (extremely infrequent, less than 1%)

Pre-Surgery Evaluation

Usually includes:

• Ultrasound neck- establishes cyst, normal location of thyroid gland.
• Thyroid features test (T3, T4, TSH) - generally normal.
• FNAC if needed (rarely)
• Treat infection preoperative with antibiotics.

Sistrunk Postoperative Recovery

• Hospital stay: Same day or 1 day
• Stitches removed in 5–7 days
• Back to routine: 5–7 days
• Full recovery: 2–3 weeks
• Light activities: 2 weeks.

Thyroglossal cyst surgery

The surgery that is considered to be the conclusive way to treat a thyroglossal duct cyst and avoid its occurrence is a thyroglossal cyst surgery. The most efficient and normal one is the Sistrunk procedure.

What is Thyroglossal Cyst Surgery?

It is a surgery that is done to amputate:

• The thyroglossal cyst
• The whole thyroglossal duct.
• The anterior part of the hyoid bone.
• This will make sure that the cyst is not recurring.

Sistrunk Procedure (Gold Standard)

• The Sistrunk operation is the surgery of choice since it is the one with the least recurrence rate.

Steps Involved:

• General anaesthesia is administered.
• The neck is cut in a horizontal incision in the middle.
• The cyst is then removed with a lot of care.
• The hyoid bone is cut and excised in the middle portion.
• The duct tract is continued till the tongue base.
• The tract and tissue attached are removed.
• The wound is stitched up with a suture.

Why the Hyoid Bone is Removed?

• The thyroglossal duct is located between the hyoid bone. Eliminating this section will eliminate repetition.

Pediatric thyroglossal cyst treatment

The most common congenital neck neck swelling in children is a thyroglossal cyst. Although it might be observed at the beginning of childhood, it might manifest at any age until adolescence. Surgical removal is the definite form of treatment of children.

First Step: Evaluation

Doctors conduct:

• Ultrasound Neck
• Confirms the cyst
• Makes sure that thyroid gland is in its normal position.

Thyroid Function Tests

• Usually normal
• Excluding any thyroid functional problems.

Discuss Infection First (If Present)

If the cyst is infected:

• Antibiotics
• Warm compresses
• Only incision and drainage in case of abscess.
• Surgery is postponed until infection subsides in order to decrease complications.

Final Therapy: Sistrunk Procedure

The gold standard in children surgery is the Sistrunk procedure.

What the Surgery Removes?

• The cyst
• The total thyroglossal duct.
• The central portion of the bone of the hyoid.

Why children need Sistrunk?

• Destroy the whole strip - eliminates the repetition.
• Risk-free operation and good long-term outcomes.
• Operated as a general anaesthetic.
• Low complication rate

Sistrunk procedure for thyroglossal cyst

The gold standard and definitive surgery of a thyroglossal duct cyst is Sistrunk procedure. It has the least recurrence rate as compared to simple cyst excision.

The Sistrunk Procedure

It is a special form of surgery used to remove:

• The complete thyroglossal duct cyst.
• Passage that is located just before the tongue.
• The major part of the hyoid bone.
• This helps to avoid recurrence and complete eradication of the embryological duct.

The Rationale behind the Sistrunk Procedure

• Thyroglossal duct runs through the hyoid bone.
• Failure to remove the central hyoid leads to cyst recurrence (up to 45-50%).
• Sistrunk decreases recurrence to 1-5 percent.
• So, it is the operation which is preferred among the world.

The Sistrunk Procedure Steps

Step 1: Anaesthesia

• General anaesthesia occurs.
• The patient is pain free and sleeps well.

Step 2: Incision

• A small slit is drawn in the neck along the middle.
• Normally fitted in a natural skin crevitude to achieve better cosmetic outcomes.

Step 3: Cyst Removal

• The cyst is removed with a lot of care to adjacent tissues.

Step 4: Exaction of the Central Hyoid Bone.

• The U-shaped bone in the neck, the hyoid bone is removed in the middle.
• This is necessary because it is penetrated by the duct.

Step 5: Tract Dissection

• The surgeon traces the duct tract upwards.
• The tissue is excised till the foramen cecum on the tongue base.

Step 6: Closure

• With sutures, the incision is closed.
• A drain can be fitted temporarily (to be removed by the same/next day)
• Duration: 45 minutes – 1 hour

Preoperative Preparation

• Neck ultrasound to identify cyst and also to detect the position of thyroid glands.
• Thyroid function tests
• FIRST If cyst is infected, Treat with antibiotics.
• Surgery is held until inflammation subsides.

Follow-Up of Sistrunk Procedure

Hospital Stay

• Majority of the patients leave within 1 night.

At Home Recovery

• Back to routine: 5–7 days
• Full recovery: 2–3 weeks
• Restrict heavy activities: 2 weeks.
• Suffering is not severe and can be treated with medication.

Wound Care

• Keep incision dry
• Follow-up in 5–7 days

Conclusion

The Sistrunk surgery is the most effective and certain treatment of a duct cyst in the thyroid glands. The operation involves removing the cyst, the whole thyroglossal tract and the centre of the hyoid bone and thus, the recurrence rate is very low with a high success and prognosis of the results. Preoperative assessment and effective surgery allow avoiding infections, decreasing complications, and offer more successful cosmetic results. The Sistrunk surgery is a safe, dependable, and lasting treatment of both children and adults with thyroglossal cysts, with adequate preoperative evaluation and postoperative treatment.

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FAQ

Does a thyroglossal cyst require surgery?

• Yes. The cyst does not fade away. The only permanent cure is surgery (Sistrunk procedure).

Is the surgery safe?

• Yes. Sistrunk is a safe and an operation that has great success.

Are there chances of a recurrence of cyst following surgery?

• The recurrence is extremely low (less than 5 per cent) when the Sistrunk procedure is properly performed.

Is it possible to perform surgery on children?

• Yes. It is commonly done on children and was deemed to be safe. Early surgery helps to avoid repeated infections.

Is the scar visible?

• The cut is made in a natural groove on the skin hence the scar is insignificant and disappears with time.

What is the consequence of failure to remove the cyst?

• It can become infected, sinuous, recurrently swell and seldom can become cancerous.