Image Based Question-66169

A patient presented with a painless swelling in the neck which moves up and down with swallowing and with protrusion of the tongue as shown in the picture below.The most common site for this swelling shown in the picture below is ?

A. Subhyoid.

B. Suprahyoid.

C. Tongue.

D. Subomohyoid.

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Correct Answer » A Explanation

Ans;A. Subhyoid.

The patient is suffering from Thyroglossal Cyst

THYROGLOSSAL CYST

• It is congenital in origin.
• It is cystic swelling developed in the remnant of the thyroglossal duct or tract.

Clinical Features:

1. Site – It may be present in any part of the thyroglossal tract (thyroglossal tract extends from foramen caecum to the isthmus of thyroid).
2. Common sites are:

• Subhyoid (most common) in the region of the thyroid cartilages,

• Suprahyoid in the floor of mouth

• Beneath the foramen caecum

1. It is a painless midline swelling, except in the region of the thyroid cartilage, where the thyroglossal tract is pushed to one side, usually to the left.
2. Mobility – Cyst can be moved sideways but not vertically
3. Peculiar characterstic which helps in distinguishing thyroglossal cyst from other neck swelling – it moves up with protrusion of tongue as the thyroglossal tract is attached to the tongue.

• It also moves with deglutition so do all thyroid swellings, subhyoid bursitis, sublingual dermoid..

Complications:

1. Recurrent infection
2. Formation of thyroglossal fistula.

• Thyroglossal cyst is congenital but thyroglossal fistula is never congenital. It follows infection or inadequate removal of a thyroglossal cyst.

• Carcinomatous change (usually Papillary carcinoma.)

Treatment:

• Excision of the thyroglossal cyst along with the track and the central part of body of the hyoid bone is the treatment of choice (Sistrunk’s operation)