Anterior lingual thyroglossal cyst: antenatal diagnosis, management, and long-term outcome

High-resolution ultrasound of thyroglossal cysts with special emphasis on the detection of cystic portions above the hyoid within the tongue base

Background

Thyroglossal duct cysts (TGDCs) within the tongue base represent a challenge for the surgeon and are often the cause of recurrence.

Purpose

This study aimed to evaluate diagnostic performance of high-resolution ultrasound in TGDCs within the tongue base, compared to intraoperative findings. Furthermore, accuracy with which the detection of thyroid tissue in parts of the thyroglossal duct cyst was possible was investigated.

Methods

A total of 50 patients with TGDCs were examined by high-resolution ultrasound. Every thyroglossal cystic lesion was examined for the presence of solid thyroid tissue with colour-coded duplex sonography and evaluated according to American Thyroid Association (ATA) guidelines. Ultimately, 45 of the 50 patients underwent surgery (Sistrunk procedure).

Results

In 38/50 patients (76%), TGDCs were seen in their typical distal location inferior to the hyoid. Four patients (8%) had the thyroglossal duct cyst superior and inferior to the hyoid. The TGDC remnants only in the tongue base were recognised in 16% of cases (8 patients). Histological specimens revealed thyroid tissue within the TGDCs in 23 of the 45 patients (49%). Thyroid tissue was diagnosed preoperatively in 15 patients (65%) X 2(1, N = 23) = 2.13, p = 0.144. One patient exhibited suspicious features for thyroid cancer, which was confirmed histologically as papillary thyroid carcinoma.

Conclusion

High-resolution ultrasound represents quick, safe and reliable imaging for TGDCs on both sides of the hyoid bone (inferior and superior) with an impact on surgical planning. Furthermore, thyroid tissue within TGDCs can be revealed preoperatively and assessed for suspicious features.

Infrahyoid Thyroglossal Duct Cyst Causing Airway Compromise in a Neonate: Surgical Management and Review of Literature

Thyroglossal duct cyst (TGDC) rarely becomes symptomatic in the neonatal period unlike other congenital neck swellings which present with high airway obstruction. An infrahyoid TGDC presenting with airway compromise in a neonate is even rarer. We hereby report a newborn with significant respiratory distress necessitating intubation and ventilation since birth. He had multiple extubation failures and signs of upper airway obstruction post-extubation. Computed tomography demonstrated a cystic lesion, probably an infrahyoid TGDC compressing the laryngeal lumen. The cyst was removed by Sistrunk procedure and histopathology confirmed the diagnosis. The child was discharged 5 days after surgery and was asymptomatic on follow-ups.

Endoscopic management of intralingual thyroglossal duct cysts: Case series and systematic review

OBJECTIVE

To discuss our institutional experience with endoscopic management of intralingual thyroglossal duct cyst (TGDC) and review cases in the published literature in a systematic review.

METHODS

Pediatric patients with intralingual TGDC treated with endoscopic surgery at our institution from 2009-2019 were identified. Metrics from our case series were then compared to those in the literature in a systematic review to assess pooled outcomes of endoscopic or transoral management. Patient demographics, age of presentation, presenting symptomatology, size of cyst on imaging, type of surgery, and post-operative outcomes were assessed.

RESULTS

We identified 5 institutional cases of intralingual TGDC and 48 cases of intralingual TGDC described in the literature. The average age of presentation was 20.36 months. 69.8% (N=37) of patients presented with at least one respiratory symptom, 22.6% (N=12) presented with dysphagia, 9.4% (N=5) presented with an identified mass in the oropharynx, and 15.1% (N=8) had the cyst discovered as an incidental finding. Three patients required revision surgeries due to prior incomplete TGDC excisions and one patient experienced a recurrence >6 months after primary excision requiring a second procedure. Our data pooled with published case series in systematic review confirms that endoscopic or transoral management are excellent options for definitive management of intralingual TGDC.

CONCLUSIONS

Intralingual TDGC is a potentially life-threatening variant of TGDC. Our results pooled with published series in a systematic review suggest that endoscopic or transoral management of intralingual TGDC are excellent minimally invasive treatments with a low risk of recurrence. Postoperative surveillance up to one year is recommended.

Characteristics of lingual thyroglossal duct cysts under flexible laryngoscopy and treatment approaches

OBJECTIVES

Lingual thyroglossal duct cysts (LTGDCs) are clinically rare and easily misdiagnosed as epiglottic cysts. Misdiagnosis leads to mistreatment; thus,simple diagnosis is important. This study aimed to investigate the characteristics of LTGDCs with flexible laryngoscopy and imaging, improve their diagnosis and explore surgical methods for patients undergoing an initial operation and patients with recurrence.

METHODS

In total, 10 patients with LTGDCs were admitted from April 2014 to December 2020.By reviewing the diagnosis and treatment of the first typical case, the characteristics of LTGDC under flexible laryngoscopy were summarized. According to these characteristic manifestations, a clinical diagnosis of LTGDC was made correctly in the other 9 patients. All 10 patients underwent preoperative CT of the neck and sagittal reconstruction and thyroid ultrasound.

RESULTS

Of the 10 patients, the first 2 patients had recurrent LTGDCs after several operations and underwent Sistrunk surgery. The remaining 8 patients were newly diagnosed and underwent endoscopic radical resection with low-temperature coblation; of these patients, 7 had no recurrence, and 1 underwent Sistrunk surgery after developing short-term recurrence. All patients were followed up for 5 months to 6 years after the last operation and were without recurrence.

CONCLUSION

LTGDCs are easily misdiagnosed as epiglottic cysts in the clinic. A correct clinical diagnosis can be made based on the characteristics according to flexible laryngoscopy. To determine the relationship between the cyst and hyoid bone, CT was performed. The surgical method was chosen based on the relationship between the cyst and hyoid bone and history of recurrence.

Large lingual heterotopic gastrointestinal cyst in a newborn: A case report

BACKGROUND

Heterotopic gastrointestinal cysts have gastrointestinal epithelium in the cyst wall and rarely occur in the oral cavity. Most are found in the neonatal period. However, heterotopic gastrointestinal cysts that are diagnosed as a congenital tongue cyst by routine ultrasonography are extremely rare.

CASE SUMMARY

A 12-day-old female presented with swelling of the anterior tongue. The obstetrician had detected significant tongue swelling on fetal ultrasonography in the 35^th gestational week. The female was born by cesarean delivery at gestational week 39. She soon became dyspneic, and the cyst was aspirated. After the aspiration, her breathing recovered and she started breastfeeding. The cyst was excised under general anesthesia on the 67^th day. Histopathologic examination showed that that cyst wall consisted of a lining of columnar gastrointestinal-type epithelium and pseudostratified ciliated epithelium. The patient restarted breastfeeding 3 h after surgery. The postoperative course was uneventful.

CONCLUSION

Airway distress and feeding difficulty were successfully avoided by cyst aspiration, and surgical resection was performed with no perioperative complications.

Prenatal Ultrasound Diagnosis of a Cyst of the Oral Cavity: An Unusual Case of Thyroglossal Duct Cyst Located on the Tongue Base

We describe a case of a lingual thyroglossal duct cyst diagnosed prenatally by ultrasound at 26 weeks of gestation. The follow-up ultrasound scans revealed no changes in the cyst measurement. Surgical treatment was performed without any complication 72 hours after delivery with good results.

Thyroglossal cyst: an unusual presentation

To highlight the difference in symptoms, clinical features and management of an intralingual thyroglossal cyst from a classical thyroglossal cyst. We present here the case of a 10 year old boy, who presented to us with the chief complaint of difficulty in speech for 2 years. A marble shaped swelling was seen on the base of the tongue. It was diagnosed as an intralingual thyroglossal cyst. He underwent a Sistrunk operation and the cyst was removed from the base of the tongue. Literature search revealed the rarity of this intralingual thyroglossal cyst, its atypical presentation and difference in way of management. A case report and review of literature regarding this unusual unusual entity is presented. An intralingual thyroglossal cyst is the rarest form of a thyroglossal cyst, and differs from a classical thyroglossal cyst totally in presentation and management.

Lingual thyroglossal duct cysts--a review

OBJECTIVES

Lingual thyroglossal duct cysts (TGDC) are rare and liable to be missed in a cursory clinical examination. This study aimed to report the details of lingual TGDC from the authors' series and review existing literature on the entity.

METHODS

A 12 year retrospective survey of all cases of thyroglossal duct anomalies managed at a tertiary teaching hospital was conducted to identify those with lingual TGDC. Their clinical presentation, investigations, diagnosis and management were analysed. Case series from anecdotal published English literature were critically reviewed with particular regard to diagnosis and management.

RESULTS

Of 78 cases of thyroglossal duct anomalies, 3 were lingual TGDC. All were females. One neonate presented with feeding difficulty and was clinically misdiagnosed as a ranula. The two older children presented with a cyst at the foramen caecum. The varied imaging and diagnostic dilemma are presented. The older children had cysts abutting the hyoid and were managed with transoral excision and a Sistrunk procedure; the neonate was managed with transoral excision only. This report also reviews the sparse literature and discusses specific issues in their treatment. The differential diagnoses encompass a wide array of developmental and neoplastic entities. Specific anatomic imaging with USG/CT/MRI and functional evaluation with radionuclide thyroid scan are essential investigative modalities. Besides a classical Sistrunk procedure and simple transoral excision, newer less invasive treatment options including marsupialisation and alcohol ablation have been reported.

CONCLUSIONS

In conclusion, the diagnosis and management of lingual TGDC needs to be individualised depending on their presentation and anatomic location. The Sistrunk's procedure is ideal for those in close proximity to the hyoid; however complete cyst excision would suffice in the rest.

Update on endoscopic management of lingual thyroglossal duct cysts

OBJECTIVES/HYPOTHESIS

Thyroglossal duct cysts (TGDC) are uncommon congenital midline neck masses arising from tubal remnants of embryologic thyroid descent. A rare variant of TGDC can present in the central tongue base and is named lingual TGDC (LTGDC). Left untreated, LTGDC may present with life-threatening airway obstruction. TGDC require surgery for cure; however, the surgical approach to LTGDC has not been discussed fully. This study was designed to examine the incidence, clinical features, and surgical management of LTGDC.

STUDY DESIGN

Retrospective chart review.

METHODS

Retrospective chart review of patients from a pediatric tertiary care institution diagnosed with lingual TGDC from 1997 to 2008.

RESULTS

One hundred eighty-nine patients underwent surgical excision of TGDC, of which 16 (8.5%; mean age, 3 years) presented with lingual TGDC alone. Most lingual TGDC were discovered incidentally, although seven patients (44%) presented with moderate to severe upper airway obstruction. Endoscopic transoral excision was performed in each case. This included suspension laryngoscopy with electrocautery, electrocautery, and cold dissection, or a combination of microdebridement and electrocautery. Most patients were intubated electively overnight for airway protection. All patients recovered without complication and have shown no evidence of recurrence (median follow-up, 3.7 years). Two LTGDC cases were revisions of prior surgeries (marsupialization and an open procedure) performed at outside hospitals.

CONCLUSIONS

Although rare, LTGDC frequently present as a prominent tongue base mass with the potential of life-threatening airway obstruction. Herein we described the typical presentation, workup, and ideal surgical approach of these lesions. Complete surgical extirpation can be performed successfully with endoscopic techniques and minimal risk of complication or recurrence.

Diagnosis and treatment of lingual thyroglossal duct cyst in newborns

BACKGROUND

The objective of this study was to explore the diagnosis and treatment method of lingual thyroglossal duct cyst in newborns.

METHOD

The clinical data of nine newborns who were diagnosed as lingual thyroglossal duct cyst were retrospectively analyzed.

RESULTS

One lingual thyroglossal duct cyst was found when the tongue was pressed with a spatula. The other eight lingual thyroglossal duct cysts were found with a laryngoscope. Three-dimensional computed tomography showed that the cysts were located at the base of tongue, which was round and smooth. Six of nine patients were treated with the puncture method. The fluid was drawn out, and the average volume was 1.4 mL. Follow-up survey lasted for 1 year or more and 33.3% (2/6) of the cases recurred. For the recurrence, the two patients underwent another operation in which most of the cyst walls were removed and they had no recurrence after another year of follow-up survey. Three of the nine patients were treated with the excision method, and they had no recurrence after 1 year of follow-up survey.

CONCLUSIONS

The laryngoscope and three-dimensional computed tomography examinations are important for the diagnosis of lingual thyroglossal duct cyst. Surgical removal serves as a radical cure for lingual thyroglossal duct cyst.

Lingual cyst with respiratory epithelium: a histopathological and immunohistochemical analysis of two cases

Cysts of the tongue are rare, usually derived from epithelia of the embryonic gastrointestinal and respiratory tracts, and classified according to the predominant epithelium lining. These cysts are usually discovered during infancy, more frequently in males, but they may not appear until well into adulthood. The authors report two lingual cysts lined mainly with respiratory, and focally by squamous, epithelium. Periodic acid-Schiff and mucicarmine staining revealed focal positivity in intracystic mucoid material and goblet cells. Immunohistochemical analysis with vimentin, cytokeratins (AE1/AE3, 34betaE12, CK1, CK5, CK6, CK7, CK8, CK10, CK13, CK14, CK16, CK18, and CK19), E-cadherin, beta-catenin, and epithelial membrane antigen showed a similar profile of normal respiratory epithelium, suggesting well-differentiated states. Owing to their controversial origin, these cysts should be named descriptively, as suggested by Manor et al., as lingual cysts with respiratory epithelium.

Lingual thyroglossal duct cyst in newborns: previously misdiagnosed as laryngomalacia

OBJECTIVE

To distinguish lingual thyroglossal duct cyst (LTDC) from laryngomalacia in newborn.

METHODS

The clinical data of five newborns who were diagnosed as LTDC were retrospectively analyzed.

RESULTS

Inspiratory stridor with chest wall retraction was cardinal symptom of newborn with LTDC. A slightly gray and round cyst with smooth surface at the base of the tongue was found with laryngoscopy. In computed tomography examination of larynx, a well-circumscribed lesion with low intensity was detected at the base of the tongue protruding into the air passage. Pathological examination demonstrated the cyst wall was composed of tabular and columnar epithelium.

CONCLUSIONS

LTDC is a common disease in newborns, which is similar with laryngomalacia. For neonate suspected of LTDC, laryngoscopy examination should be taken first, while laryngeal CT scan is an important diagnosis basis to be reg. Cyst puncture can ameliorate the symptoms of LTDC, while surgical removal serves as a radical cure for LTDC.

Thyroglossal duct cyst: personal experience and literature review

The thyroglossal duct cyst [TDC, or thyroglossal tract remnant (TTR)] is a well recognized developmental abnormality which arises in some 7% of the population. As a consequence, it represents the most common type of developmental cyst encountered in the neck region. It typically presents as a mobile, painless mass in the anterior midline of the neck, usually in close proximity to the hyoid bone. Less often, TDCs may present with signs and symptoms of secondary infection, or with evidence of a fistula. While TDCs are most often diagnosed in the pediatric age group, a substantial minority of patients with TDCs are over 20 years of age at the time of diagnosis. The standard surgical approach to TDC, encompassing removal of the mid-portion of the hyoid bone in continuity with the TDC and excision of a core of tissue between the hyoid bone and the foramen cecum, dates back to the late 19th and early 20th centuries and is often referred to as Sistrunk's operation. Malignancy is rarely encountered in TDCs; when such rare tumors do develop (in the order of 1% or so of patients with TDCs), they usually take the form of either papillary carcinoma of thyroid origin, or squamous carcinoma.