A 44 y.o. male presents with a sore throat

What do you notice on imaging?

 hint: it's near the epiglottis

hint: it's near the epiglottis

Our patient had a thyroglossal duct cyst. 65% of the time they are a midline neck mass below the level of the hyoid bone and can be seen moving with swallowing.  Our patient had one at the base of the tongue;  unusual in that it was not below the hyoid. .  The persistent duct can promote oral secretions and the cysts can become infected.  The tract can lie dormant for decades and present in later life. The cyst can rupture creating a draining sinus known as a thyroglossal fistula. Another complication is malignancy; with remnants of thyroid tissue in the cyst becoming malignant. Carcinoma occurs in 1-2% of thyroglossal duct cysts.

 cysts can occur anywhere along the thyroglossal duct tract

cysts can occur anywhere along the thyroglossal duct tract

During embryonic development, the thyroid gland is formed at the base of the tongue  and moves caudally down into the neck through a canal known as the thyroglossal duct.  The duct normally disappears after the thyroid is formed but can leave behind remnants of the duct which cause cysts.

Since most of the cysts are below the hyoid; the classic treatment is resection of the center of the hyoid bone and removal of 1/8 inch of core of the tongue superior to the hyoid.  The hyoid is then reconnected. This is called the Sistrunk procedure and is 95% effect at removing the cyst.

 more common location of a thyroglossal duct cyst

more common location of a thyroglossal duct cyst

Our patient was treated with unasyn and steroids. He improved and was discharged for outpt direct laryngoscopy and biopsy.  He was quite upset that when he was initially seen in ent clinic the CT did not show a cyst and then it recurred several weeks later.

McNicoll MP, Hawkins DB, England K, Penny R, Maceri DR. Papillary carcinoma arising in a thyroglossal duct cyst. 1988 Otolaryngology-Head and Neck Surgery 99(1) 50-54.

Deaver MJ, Silman EF, Lotfipous S. Infected thyroglossal duct cyst. 2009 Western Journal of Emergency Medicine 10(3):205.

Sistrunk WE The surgical treatment of cyst of the thyroglossal tract. 2016. Annals of Surgery 71(2):121-122.

Maddalozzo J, Venkatesan TK, Gupta P. Complications associated with the Sistrunk procedure. 2001 The Laryngoscope 111(1):119-123.