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THYROGLOSSAL DUCTCYST



Ghaneim and Atkin indicated, while TDC isfound in between hyoid bone and the thyroidcartilage in about 60% of the patients, it issuprahyoid, supra-sternal and intralingual inabout 24%, 13% and 2% respectively

Histologically cyst lined: stratified squamousor pseudo stratified ciliated columnar epithelium.

Thyroglossal Duct Cyst—More Than Just an Embryological RemnantSujatha Narayana Moorthy & Rekha Arcot Indian J Surg (January–

February 2011) 73(1):28–

31



typical CT appearance of a TDC is a low-density, usually unilocular but occasionallyseptated, well-circumscribed lesion with well-defined walls.

Peripheral rim enhancement is sometimesobserved on post-contrast images

Computed Tomographic Evaluation of Thyroglossal Duct Cysts inChildren Under 11 Years of Age Dong Hoon Lee,et.al Departments of Otolaryngology-Head and Neck Surgery & 1Radiology, 2Research Institute of Medical Sciences, Chonnam National

University Medical School & Chonnam National University Hwasun Hospital, Hwasun,Korea



Ultrasonography (US) should serve as the primaryinitial imaging modality in children for palpablemasses and assessment of superficial glandular

structures, such as the thyroid gland and salivaryglands.

Advantages: ready availability and quickinterpretation, cost-effectiveness, lack of radiationexposure, and no requirement for sedation.

Huoh et al. demonstrated that US is equally accuratecompared to MRI and CT with superiority over theother two modalities in cost and safety.



typical sonographic description of a TDC :anechoic, well-circumscribed cyst withincreased through-transmission .

However, earlier studies in children haveshown that most are not simple cysts butinstead are either homogeneous or

heterogeneous complex hypoechoic lesions

Thyroglossal Duct Cysts: Sonographic Appearances in AdultsAnil T. Ahuja, Ann D. King, Walter King, and Con Metreweli. AJNR Am J Neuroradiol 20:579 – 582, April 1999



anechoic (28%),

homogeneously hypoechoic with internaldebris (18%)

pseudosolid (28%)

heterogeneous (28%).

posterior enhancement (88%) midline (63%)

infrahyoid in location (83%)

Only half of all TDCs showed a typical thinwall

Thyroglossal Duct Cysts: Sonographic Appearances in AdultsAnil T. Ahuja, Ann D. King, Walter King, and Con Metreweli. AJNR Am J Neuroradiol 20:579 – 582, April 1999



On contrast-enhanced CT images, a thyroglossalduct cyst appears as a fluid-like mass with uniformlythin peripheral rim enhancement (Fig. 5).

With MRI, a thyroglossal duct cyst presents as ahypointense lesionon T1-weighted images and ahyperintense lesion on T2-weighted images; ectopicthyroid tissue also shows marked gadoliniumenhancement. Septations are rarely observed (19).

On US examination, a thyroglossal duct cyst usuallyappears as a cyst-like anechoic mass with a thinouter wall in this characteristic location.



OPERATIVE TECHNIQUE

Transverse incision made inskin fold over the mass

Skin flaps elevated in thesub-platysmal plane and anellipse of fascia overlyingthe cyst is outlined.

Sternohyoid muscleseparated in the midline

and retracted laterally,exposing the cyst, inferiorto the hyoid bone



OPERATIVE TECHNIQUE

Mylohyoid and geniohyoid ms are detachedfrom the superior aspect of the body of thehyoid bone. Incision is deepened until thesubmucosa of the superior hypopharynx isexposed



The body of the hyoid bone is severedthrough its point of fusion with the greatercornu on each side. (separates it from thethyrohyoid membrane); at times there is apatent duct communicating with the lingualwall of the valeculla at the foramen cecum



With the body of the hyoid bone completelydetached from the cornua, traction on thecyst and deep dissection is done to track thetract. Ellipse muscle tissue is excised incontinuity with the hyoid bone. Incisionconfined to midline to avoid injuries to

hypoglossal nerve.



Bed of resected hyoid bone is closed bysuture of the suprahyoid to the infrahyoidmuscles



LINGUAL NERVE

ipsilateral sensitive innervation of the tongue,inferior gum and mouth floor, causing loco-regional hyposthesia or paresthesia if damaged.

it is responsible for taste in the anterior two-thirds of the tongue through the chorda

tympani nerve (facial nerve branch) and forthe innervation of the submandibular glandthrough parasympathetic fibers.



LINGUAL NERVE

Posterior branch of themandibular nerve in thepterigopalatine fossa, it meetsthe chorda tympani (with facialnerve fibers) and goes

downwards, between themedial and lateral pterigoidmuscle and, afterwards, itpasses between the medialpterigoid muscle and themandible. Then, the nerve

crosses over the hyoglossalmuscle as it originates theterminal branches deep in thetongue.



Hypoglossal nerve

Injuries to this nerve impairs tongue motorfunction, making it deviate to the injury sidewhen the inferior motor nerve is injured,

Dziewas and Lüdemann17 described a seriesof hypoglossal nerve injuries in 2002,reporting 6 cases related to prior suspension

laryngoscopy, and 5 out of the 6 reportedcases improved.



this nerve emerges from the

medulla oblongata and hasits apparent origin in thecranial vault through thehypoglossal canal, movingdownwards between the

great veins of the neck allthe way to the mandibleangle. It then moves belowthe digastric muscle, itpenetrates the oral cavity

and innervates all theintrinsic and extrinsictongue muscles, except thepalatoglossal muscle

thyro gloss al duct cyst leck o

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