Thyroglossal Cyst – Its Excision and Recurrence
Q: My son, at the age of two developed a neck abscess which burst and started leaking pus through the skin. We then rushed him to hospital and we saw a general surgeon who drained the abscess. It re-occurred within a month and was drained again. It started leaking through a hole in his neck, at which point we went to a Pediatric Surgeon. He diagnosed it as a thyroglossal duct cyst. The cyst was removed along with the small hyoid bone to prevent further cysts from developing. Unfortunately removing the hyoid bone didn’t seem to have helped. After numerous procedures we were referred to a Professor ENT Surgeon.
To cut a long story short, he had 2 years of cyst removals, continuous leaking from a small hole in the neck. He also had 3 MRI Scans and 11 procedures involving drainage and operations. In the last operation he had on 29 November 2012, they removed yet another large cyst which was picked up on an MRI Scan. It has recently filled up again with tacky clear fluid and eventually popped last night and drained on its own. We can not get to the bottom of this; just as we think it’s over, we see a lump and it starts all over again. Please can you advise us as to what direction we should follow? Have you heard of any cases like this before? Many thanks.
By: Clive
Reply:
Let us first understand the nature and origin of this structure.
The original position of the thyroid gland was foramen cecum and not the neck. This foramen resides in the skull area.
An evolutionary descent of this gland has occurred, placing it to its final position in the front of the neck. So there exists a persistent epithelial tract from foramen cecum to the place in front of the neck. This tract is the thyroglossal duct.
The tract is not straight. It has kinks at places, which make it prone to cyst formation. A cyst is nothing but a fluid filled sac.
Why Do We Need to Remove Such Cysts?
Cyst removal is always essential because of the following reasons-
- It may grow in size, pressing other nearby structures.
- It frequently gets infected because of its location.
- It may burst inside the body.
- If a cyst tends to burst outside the body, it may lead to a sinus or fistula formation. So drainage of recurrent cysts from the same site again and again can be dangerous. It almost always leads to formation of a fistula.
About the Surgery
The surgical procedure for removal of TGCs (Thyroglossal cyst) always involves the removal of the cyst along with the epithelial tract of the sinus formed and its branches, if any. If even a little portion of the tract is left behind, the cyst may recur.
Also a portion of the hyoid cartilage is removed. This is because the cells over the cartilage , having same embryonic origin, can re-produce the cyst.
The procedure is called sistrunk operation. In most of the cases, the cyst does not occur again after this en block excision.
Recurrence After Removing It Surgically
However, there have been other cases like your son, where the cyst still recurs back in spite of such a radical excision.
Any tissue left behind, which still maintains the epithelial origin of this duct, can give rise to a cyst. Now, the suspicion goes towards an intralingual remnant of the duct.
In such cases, a piece of tongue tissue (from the base area) around the foramen cecum needs removal. This ensures the removal of any intralingual component of the duct.
The surgery would involve a combined transoral and cervical approach.
Unfortunately, there is no other way than further surgical excision. Till all the tissue capable of giving rise to the thyroglossal duct tissues are removed, recurrences may be there.
Read here more about the structural course of the duct.
Take Care,
Buddy M.D.
Many thanks for your informative reply. Just another question on the matter.
Whenever my son gets a cold, flu or sinus infection, we have noticed that a lump forms in his throat. In most cases it leads to this lump bursting and leaking.
Could this be a result of a Fistula? If so, what procedure do we follow to fix the Fistula? Thanks again.
Cold/flu viruses affect the throat area. So any infection there, is likely to produce a lump in the neck. Repeated bursting or drainage of these lumps outside through an opening, do suggest the presence of a sinus or a fistula.
The appropriate procedure can be decided only after actual physical examination.
Thank you for sharing your experience. This condition can be challenging to manage and as you highlight. By using Sistrunk’s Procedure I’ve been able to cure most patients with one operation.
If you would like more information about thyroglossal duct cyst treatment and Sistrunk Procedure please see my website: http://www.ent-surgery.com.au/thyroid/thyroglossal-duct-cyst-surgery-sistrunk-procedure/
Hi, I’m having thyroglossal duct cyst surgery next month and really worried as I’m on loads of medication for treating a brain tumor. How easy is the operation ?
I’m really worried about my tables can they mix? Should I take them near the time of the surgery?
Thanks Liam
The operation required for removal of the cyst is called sistrunk operation. It is not a risky operation. However, the operation requires a lot of skill and fine hands of an expert surgeon. If not done properly, the cyst may recur.
Read above in details about the operation and thyroglossal cyst.
What all tablets are you taking? It would be good to inform your doctor, who is handling this operation, about all the medications you are taking.
Dostinex tab
Desmopressin
Carergoline
Hydrocortisone
Levothyroxine
And growth hormone
You may continue with your medications. They are all essential to treat your brain tumor and are unlikely to interfere with the medication required for the operation.
However, it is important to inform the surgical team treating you about these medications.
Hi, My daughter was 2.6 years when her neck got swollen but no one was able to identify it as a Thyrogloassal duct cyst. with anitbiotics the swollen neck reduced but still she had a ball like figure on her neck. This year when she was 3.6 (Apr’17) her neck got swollen again and it was discovered that she had a thryglossal duct cyst. we have scheduled her surgery in 2nd week of november but am worried because of the following reasons:
1. the cyst colour has become red
2. it seems that the cyst seems to change little places (from left to right slightly)
3. the skin of the cyst has become slightly rough
4. it appears as if there is some pus (white in colour) inside the cyst
I am worried as will the above symptoms interefere with her surgery?
Also if there is any home precautions i should take before or after the surgery, please advise
The cyst looks inflamed now.
Your doctor may need to put her on an antibiotic cover from 3 to 4 days before the surgery. This will take care that the surgery is done safely.
Hi there, my 3.5 year old has recently been diagnosed with a thyroglossal duct cyst and we are due to have it removed at the end of the week.
Back in January it became infected and she was put on a course of antibiotics, which cleared it up. However, after the course of antibiotics it popped and ever since the lump has drastically reduced and there is a scab that leaks (a thick ckear liquid) every time it is knocked.
My question is will the surgery still take place with these symptoms?
Yes.
Thyroglossal duct cyst measures near to 2cm
Voice changes- hoarseness
Clearing throat all the time
Sometimes difficulty swallowing
Sometimes breathing difficulties in sleep
Feels like a sore throat that never goes away
Chronic fatigue
Cancer?
Age? Any history of weight loss?
27
Putting on weight was always a problem
Though it’s unlikely to be cancer, you may opt for a diagnostic biopsy to be sure.
Your cyst alone may be giving you those symptoms. Discuss with your doctor about its corrective surgery.
Ok thank you.
Welcome.
I am Lyton, I have been found to have a hypoglossal cyst on my throat. My doctor suggests we drain it, won’t it reccur?
Most of them may recur without excision excision.