Thyroglossal Cyst & Fistula

Thyroglossal duct is a fluid filled sac resulting from the incomplete closure of the thyroglossal duct.

Incidence : Less than 1% | Male : Female ratio : 1 : 1


Site Of Thyroglossal Cyst

May present at any place from foramen caecum to isthmus of thyroid gland
Majority is found in the midline (90%)
10% can be found in one side of midline, usually the left


Presentation Of Thyroglossal Cyst
1. Usually present in children
2. Painless swelling in the midline of the neck
3. Moves upwards during protrusion of the tongue (If attached to hyoid bone) / during deglutition (If attached to isthmus of thyroid)
4. May become infected and present as a red painful swelling in the neck
5. Consistency is cystic
6. Transillumination test is negative
7. Skin pinch is positive
8. Slip test is positive


Investigations Done For Thyroglossal Cyst

1. Ultrasonography
2. CT scan
        Well circumscribed cyst related with the midline of the hyoid bone
3. Fine needle aspiration
        Cloudly infected fluid or a straw coloured fluid


Treatment Of Thyroglossal Cyst

Infected thyroglossal cyst
        Antibiotics
        Surgical drainage if abscess is formed / when there is no response to medical treatment
        Elective excision of the cyst after subsidence of infection

Surgery

        Excision & biopsy – Sistrunk procedure


Complications Of Thyroglossal Cyst

1. Recurrent infection
2. Thyroglossal fistula
3. Chance of malignancy (Rare)


Thyroglossal Fistula

It is an acquired fistula, which occurs….
        Following an infection of thyroglossal cyst which burst open
        After inadequate removal of the cyst

Features Of Thyroglossal Fistula

1. Lined by columnar epithelium
2. Discharge mucous from the fistula
3. Hooding of the skin is seen at the opening
4. Semilunar sign – Peculiar crescentic appearance
5. Site : Just below the hyoid bone

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