Infrahyoid Region Research Articles

Papillary Thyroid Carcinoma of a Large Thyroglossal Duct Cyst: A Case Report

Background: Thyroglossal duct cyst is the most common congenital anomaly of the thyroid gland. Carcinoma arising from it is rare which composes 1% of total cases, often diagnosed incidentally after surgical excision. Here we are reporting a case of papillary thyroid carcinoma of thyroglossal cyst in 45-year-old female with normal thyroid gland. Case Description: A 45-year-old female presented with 1 year history of swelling over midline of the neck with normal thyroid gland. FNAC suggested a benign cystic lesion, most likely thyroglossal cyst. CT scan neck showed a well-defined lobulated and septated thin-walled cystic lesion of approx. 6×4×5cm in the midline upper infrahyoid region anterosuperior to thyroid, suggestive of thyroglossal cyst. Sistrunk procedure was performed. HPE revealed papillary thyroid carcinoma of thyroglossal cyst. Conclusion: A case of thyroglossal duct cyst with normal thyroid gland and without any clinical or radiological evidence of malignancy, a possibility of underlying malignancy should be kept in mind and can be managed adequately with Sistrunk procedure only, with regular follow up.

Thyroglossal cyst – A retrospective analysis in a tertiary care center

Background: Thyroglossal duct cyst (TGDC), one of the most common congenital neck lesions, is due to the persistence and dilatation of remnants of an epithelial tract, formed during migration of the thyroid in embryogenesis. Aims and Objectives: The objective was to study the location of TGDC in different age and sex groups and variations in presentation. Materials and Methods: A retrospective study was carried out in the Department of ENT at Assam Medical College and Hospital, Dibrugarh from July 2018 to June 2023. The diagnosis was made on the basis of fine-needle aspiration cytology and ultrasonography. Results: A total of 25 cases were analyzed. Majority of them belonged to the age group of 11–20 years. Male: female ratio was 2:3. Nearly 100% of cases had a chief complaint of midline neck swelling that moves with protrusion of the tongue. Most common site of occurrence is the infrahyoid region. Nearly 80% of cases underwent Sistrunk operation. Conclusion: Thyroglossal cyst with its varied presentation is notorious for recurrence. Proper evaluation and excision are the keys toward successful outcomes.

Cervical Aggressive Fibromatosis Causing Airway Obstruction.

Fibromatosis or desmoid tumors are rare benign fibroblastic lesions that are rarely present in the head and neck regions. When they do occur in these regions, however, they tend to be aggressive toward the surrounding tissue and be associated with heavy morbidity and mortality. We report the case of a 26-year-old Tunisian female who presented with acute obstructive dyspnea and a 3-week history of cervical swelling. The swelling was initially only located in the left submandibular area, it then gradually extended to all the anterior cervical supra- and infrahyoid regions causing a clinical presentation resembling that of obstructive dyspnea, the patient was admitted, and an emergency tracheotomy was performed. Tissue samples were taken, pathological analysis revealed an aggressive case of fibromatosis. The patient was treated with corticosteroids and antihormonal therapy, the fibrous mass shrunk considerably allowing the removal of the tracheotomy cannula, no tumor recurrence was noted during the observation period. Due to the rarity of this disease, especially in the cervical region, there are no therapeutic guidelines available.

Lemierre's Syndrome in Pediatric Patients: Case Report

Introduction: Lemierre's syndrome is a severe and extremely rare septic thromboembolic event of an infection usually located in the neck and head. It is a rapidly progressive disease that can cause fatal consequences when there is no timely treatment. Clinical Case: A 6-year 5-month old female patient was evaluated due to a clinical picture of a continuous burning pain in the left anterior cervical region of moderate intensity of 3 weeks of evolution that worsens with a sudden mass growth at the mentioned level. Physical examination revealed an asymmetric neck with limited mobility due to the presence of an oval mass of approximately 6 cm in diameter located in the left anterior cervical quadrant. A CT scan showed an invasive process in the left infrahyoid region that is enhanced with the use of intravenous contrast medium, measuring 4.7 cm x 3.8 cm x 4.2 cm, with an approximate volume of 39 ml. In addition, a hypodense image is observed in the left internal jugular vein suggesting thrombosis. Drainage of a cervical abscess is performed, revealing a mass in the left external segment. The result of the study of the collected purulent fluid reports isolation of two types of germs: Bacteroides fragilis and Peptococus species. Considering also the radiological finding of the internal jugular vein thrombosis, anticoagulation with low molecular weight heparins was started. Patient with good evolution of clinical picture. Conclusions: Lemierre's Syndrome is a disease in which early diagnosis and treatment can reduce morbidity and mortality, especially in pediatric patients, where its incidence is extremely rare. However, specific clinical data can guide us to its diagnosis.

Symptomatic Thyroglossal Duct Cyst Presenting With Synchronous and Localized Tongue Base Extranodal Mantle Cell Lymphoma. A Unique Case Report Demonstrating Lymphoma Colonization of Cyst Wall, Potentially Relating to a Persistent Embryological Foramen Cecum Remnant

A 77-year-old male presented with a progressively enlarging midline neck mass. On further investigation he was found to have synchronous thyroglossal duct cyst and extranodal mantle cell lymphoma (MCL) localized to the base of tongue. Both pathologies were managed simultaneously with a surgical approach and the patient remained in clinical remission at the time of publication without indication for systemic oncological treatment. Histology revealed primary extranodal nonblastoid MCL forming a base of tongue mass, with colonization of the thyroglossal duct cyst. Lymphoma was also found in the epithelium of a crypt-like tract traversing one of the tongue base tumor sections. This tract was anatomically and histologically consistent with documented descriptions of the foramen cecum. This case report illustrates a previously undescribed temporal, clinical, and histological association between a base of tongue MCL and symptomatic thyroglossal duct cyst. We provide evidence for a potential causal relationship for the presentation of the thyroglossal duct cyst as a result of oropharyngeal MCL, in the absence of clinical and histological evidence of disseminated disease, directly infiltrating from its tongue base origin to the infrahyoid neck region, potentially via an embryologic foramen cecum remnant. We also highlight the crucial role of the histopathologist in multidisciplinary clinicopathological discussion in demonstrating how fundamental embryological and microanatomical relationships can unite apparently separate diseases.

Cervicofacial lymphatic malformations: diagnosis and management

BackgroundLymphatic malformations are rare benign tumors that result from congenital and acquired alterations of the lymphatic vessels. They occur most commonly on the head and neck region.The aim of this study is to describe clinical profiles of lymphatic malformations of the head and neck (LMHN) as well as to study therapeutic modalities through our series and review of the literature.ResultsThis is a retrospective record-based descriptive study conducted in the ENT and the Radiology departments over a 17-year period. Our study included twelve patients, aged between 8 months and 52 years. Two swellings were present at birth and had not been prenatally diagnosed in both cases. One patient was affected by TRISOMY 21.All patients consulted for a painless mass of the head or neck. Seven masses were located in the suprahyoid region and five in the infrahyoid region. Ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) were realized to establish the diagnosis and assess the extent of the lesions.Surgical excision was performed in 7 patients. It was complete in 6 patients. Five patients were treated with sclerotherapy. The sclerosing agents used were Aetoxisclerol 2%, hypertonic saline, and absolute alcohol. One patient had a reversible paresis of the left mental nerve after surgery. An excellent response to sclerotherapy with complete resolution was obtained in 3 cases with no recurrence of the disease.ConclusionsSurgical excision has been the management option of choice for LMHN. The recent advances in sclerotherapy make it safe and effective as a primary treatment modality for these lesions.

English

BACKGROUND Thyroglossal duct cyst is a developmental cyst that occurs in 7 % of the population. These cysts are most commonly seen in paediatric patients. They occur due to failure of thyroglossal duct to involute and atrophy. Majority of them are found in infrahyoid region. The purpose of this research was to summarise our three years of clinical experience in different features of thyroglossal cysts and their surgical results, with an emphasis on the naked eye extent of a patent thyroglossal duct if present. METHODS This observational study was carried out in the Department of ENT, GVP IHC & MT – Visakhapatnam district, Andhra Pradesh for a period of three years from January 2016 to 2019. In our study, twenty patients were enrolled. Patients with cysts were initially diagnosed based on medical history, clinical examination, and ultrasound sonography (USG) reports. RESULTS Patients' clinical and surgical data, including cyst size and position, presence or absence of the thyroglossal duct, and so on, were analysed. The average age was 11 years. The majority (73.5 percent) were under the age of 15. Males accounted for 75 percent of the population, while females accounted for 25 %. Midline neck swelling was found in most of the patients (95 %). Majority (84.5 %) of cysts were located in the sub-hyoid region. Erythema over swelling was seen in 14.5 % of patients. Thyroglossal ducts were found to be patent at various lengths and areas. Majority of patients (75 %) had tract that began from cyst and ended at superior border of hyoid body while two patients (10 %) had patent thyroglossal duct from the cyst to the vallecular mucosa. Majority (70 %) cysts had size between 1.6 cm and 3 cm. Intraoperatively 15 % of cyst got ruptured. Most of them were present with visible midline neck swelling. None of the cysts had malignant characteristics in our study. CONCLUSIONS In most cases, a patent duct just disappeared at the superior border of body of hyoid. Complete patent thyroglossal duct from cyst to tongue musculature was rare. None of the cysts had malignant characteristics in our study. KEYWORDS Thyroglossal Cyst, Neck Swelling, Thyroglossal Duct

Clinicopathological Study of Thyroglossal Cyst

Background: Thyroglossal cyst is a congenital malformation that occurs due to incomplete closure of the thyroglossal duct. Apart from quiescent embryological remnant, it presents clinically as a midline cystic swelling that moves with tongue protrusion; present at any age, often requires surgical excision.
 Objective: To evaluate the clinical features and treatment outcomes of patients with a thyroglossal duct cyst.
 Material and methods: This observational study was carried out in the Department of Surgery, Dept. of Otolaryngology, Ibn Sina Medical College, Dhaka, A total 40 cases of both sexes with the age 6-67 years, during the period of 2013 to 2018 (5 years)
 Results: A total 40 cases of thyroglossal cyst with mean age of 24.37 years were included in study. Of the total 40 cases, 20 (50%) patients were male and 20(50%) were female. Most common clinical presentation was painless midline cystic swelling was the main complaint in 30 patients (75%), followed by dysphagia 5 (12.5%), Sore throat 3 (7.5%) and globus 2 (5%) in descending order. Most common location of cyst was in infrahyoid region in 26 patients (65%), suprahyoid in 14 patients (35%).
 Conclusion: The most common presentation of thyroglossal cyst is a midline cystic swelling that moves with tongue protrusion. The standard surgical approach to thyroglossal cyst is Sistrunk’s operation with low recurrence rate. Malignancy within thyroglossal cyst is very rare but should be rule out in all cases.
 Bangladesh J Otorhinolaryngol; October 2020; 26(2): 153-157

Effect of Vocal Therapy Associated With TENS in Women With Behavioral Dysphonia

This study aimed to investigate the effect of transcutaneous electrical nerve stimulation (TENS) associated with vocal therapy in women with behavioral dysphonia. Seventeen women with behavioral dysphonia were divided into an experimental group (n=8) and a placebo group (n=9). All were submitted to six sessions of vocal therapy, according to the Comprehensive Voice Rehabilitation Program. In the experimental group, therapy was associated with TENS (30 minutes) and in the placebo group, the electrodes were placed and the equipment remained off. The vocal handicap, the voice through the acoustic and auditory perception evaluation, the electrical activity, and the superficial temperature of the suprahyoid and infrahyoid muscles were evaluated. Pre and post data were compared by parametric and nonparametric tests. There was a decreased in vocal handicap of the placebo group (P=0.002) and a decreased in the percentage of electrical activity of the right (P=0.036) and left (P=0.017) infrahyoid muscles of the experimental group in vowel emission and sequential speech (P=0.036). There was an increase in temperature in the right infrahyoid region in vowel emission (P=0.027) and the temperature difference decreased quantitatively between the supra and infrahyoid regions in the experimental group. TENS associated with vocal therapy reduced the electrical activity of the infrahyoid muscles and balance the temperature between the supra- and infrahyoid regions in women with behavioral dysphonia.

Effects of neuromuscular electrical stimulation in patients with Parkinson's disease and dysphagia: A randomized, single-blind, placebo-controlled trial.

Neuromuscular electrical stimulation has been used to improve swallowing function in neurologic patients with dysphagia, but its effect on patients with dysphagia and Parkinson's disease remains unclear. This study aimed to identify the effect of effortful swallowing combined with neuromuscular electrical stimulation as a novel treatment approach in dysphagic patients with Parkinson's disease. Participants were randomly allocated to an experimental group (n = 9) or a placebo group (n = 9). The experimental group simultaneously received neuromuscular electrical stimulation with effortful swallowing, while the placebo group received sham neuromuscular electrical stimulation with effortful swallowing. All participants received the treatment for 30 min/day at five sessions per week for 4 weeks. Both groups also received the same conventional dysphagia therapy. The experimental group showed significant differences in horizontal movement (p = 0.038) and vertical movement (p = 0.042) compared to the placebo group, but showed no significant differences in the oral (p = 0.648) or pharyngeal phase (p = 0.329) of the Videofluoroscopic Dysphagia Scale compared to the placebo group, except for the Penetration-Aspiration Scale (p = 0.039). We demonstrated that neuromuscular electrical stimulation applied to the infrahyoid region combined with effortful swallowing effectively increased hyoid bone movement and reduced aspiration in dysphagic patients with Parkinson's disease.

Dual ectopic thyroid associated with thyroid hemiagenesis.

SummaryWe report a case of a 15-year-old girl with a midline neck mass that was first noted 2 or 3 years previously. She had been treated with levothyroxine (L-T4) for congenital hypothyroidism until 11 years of age. Ultrasonography revealed an atrophic right thyroid (1.0 × 1.6 × 2.6 cm in size) and a mass (2.3 × 1.0 × 3.5 cm in size) in the upper part of the neck. No left lobe of the thyroid was detected. On further evaluation, Tc-99m pertechnetate thyroid scintigraphy and CT showed ectopic thyroid tissue in the lingual region and infrahyoid region. Thus, she was diagnosed as having dual ectopic thyroid and thyroid hemiagenesis. The atrophic right thyroid was thought be non-functional. Treatment with L-T4 was started to reduce the size of the dual ectopic thyroid tissue. This may be the first reported case of dual ectopic thyroid associated with hemiagenesis detected only by ultrasonography.Learning points:Ultrasonography can confirm the presence or absence of orthotopic thyroid tissue in patients with ectopic thyroid.The cause of congenital hypothyroidism should be examined.Clinical manifestation of ectopic thyroid may appear when the treatment with L-T4 is discontinued.Annual follow-up is needed in all children when their thyroid hormone replacement is stopped.

The effect of surface neuromuscular electrical stimulation on patients with post-stroke dysphagia.

To assess whether the clinical efficacy of a therapeutic protocol using surface neuromuscular electrical stimulation (sNMES) on patients with post-stroke dysphagia (PSD) is superior to that without sNMES, and whether swallowing functional outcome is different with regards to different electrode placement on patients' skin of neck. Thirty patients with PSD were randomly allocated into treatment group A (TGA), treatment group B (TGB) and control group according to a random number table. The three groups of patients all received traditional dysphagia therapy (TDT) and other general rehabilitation therapy such as physical therapy and occupational therapy as a basic treatment project. Besides this, sNMES treatment was applied on different sites of patients' neck skin in group A and B separately. All the patients received video-fluoroscopic swallowing study (VFSS) pre-treatment and 2 weeks post-treatment, during which the displacement of the hyolaryngeal complex towards the superior and anterior sides while swallowing semi-liquid diet were measured. Outcome of the VFSS was measured using dysphagia outcome and severity scale (DOSS). Post-treatment evaluation was carried out using water swallow test (WST), repetitive saliva swallowing test (RSST) and dysphagia outcome and severity scale (DOSS) from the three study groups were all improved (P< 0.05). The results of post-treatment evaluation using WST from TGA and TGB were 2.40 ± 1.26 and 2.10 ± 0.99 respectively, using RSST from TGA and TGB were 5.30 ± 1.89 and 5.20 ± 1.69 respectively, using DOSS from TGA and TGB were 5.20 ± 1.40 and 5.10 ± 1.45 respectively. Compared to control group, the results of post-treatment evaluation using the three scales, there were significant improvement between TGA and TGB (P< 0.05), however, the inter-group differences of TGA and TGB indicated no statistically significant difference (P> 0.05). The post-treatment evaluation of the moving distance of hyoid bone towards anterior side in swallowing was significantly improved as compared to TGB (-8.40 ± 7.48, t=-3.552, P= 0.006), and was statistically significant as compared to the control group (P> 0.05). Swallowing function in the patients with PSD was significantly improved using TDT combined with NMES. Stimulating electrodes placed at the suprahyoid region or on both suprahyoid and infrahyoid regions resulted in no difference of effect. However, NMES on suprahyoid region could further improve the moving distance of hyoid bone anteriorly.

Thyroglossal Duct Cysts: A Clinicosurgical Experience.

Thyroglossal cyst is the most common congenital neck mass and occurs in 7% of the population. They occur due to failure of thyroglossal duct to involute and atrophy thyroglossal duct cysts often occur in pediatric patients. Majority of them are found infrahyoid region. The purpose of the present study is to report our 5year clinical experience of thyroglossal cysts in terms of clinical features and surgical findings with special emphasis on naked eye extend of patent thyroglossal duct when present. To the best of our knowledge this is first clinical study which has reported the extend of thyroglossal duct on naked eye. This prospective observational study was done in the Postgraduate Department of ENT, Head and Neck surgery of Government medical college, Srinagar for a period of five years from January 2011 to January 2016. Thirty patients of histopathologically confirmed thyroglossal cysts were enrolled in the study. Patients were initially diagnosed on the basis of clinical history, examination and USG findings suggestive of cyst. Clinical data and surgical data in terms of size and location of cyst, presence or absence of thyroglossal duct etc. was analyzed and formulated in tables for patients who had histopathologically confirmed cyst. Mean age was 10years. Majority (73.3%) were less than 15years of age. Males were 22 in number (73.3%) while females compromised 26.7% of population. Ninety percent of patients presented with neck swelling. Erythema/redness over swelling was seen in 13.3% of patients. Majority (83.3%) of cysts were subhyoid in location. Thyroglossal ducts were seen to be patent for different lengths and areas. Majority of patients (80%) had tract arising from cyst and disappearing at superior border of hyoid body while three patients (10%) had patent thyroglossal duct from cyst to vallecular mucosa. A complete patent thyroglossal duct was seen in one patient (3.3%) from cyst to base of tongue. Complete Absent tract was seen in two patients (6.7%). Majority (70%) of cysts were having size between 1.6 and 3cm. Intraoperative 10% of cyst got ruptured. Thyroglossal cysts are most commonly seen in pediatric males. Most of them present with visible midline neck swelling. In few cases cyst can rupture after repeated infections leading to sinus formation. Most of them are subhyoid in location. These cysts are usually of size 1.5-3cm. Complete patent thyroglossal duct from cyst to tongue musculature is rarely seen while most of the times, a patent duct just disappears at the superior border of body of hyoid. None of our cysts had malignant features.

Thyroglossal Cyst in Children: Presentation, Diagnosis and Managment Outcome in the Context of Bangladesh

Background and Objectives: Thyroglossal duct cyst (TDC) is considered to be the most common congenital neck swelling in children. But its diagnosis can sometimes be challenging, because of abnormal presentation or associated infection. The aim of the present study is to describe the clinical features, anatomical location and management given to these children in the context of Bangladesh.&#x0D; Methods: This retrospective review of the past 7 years' (between June 2008 and July 2015) records of all children with a histopathologically confirmed diagnosis of TDC was done at the Department of Pediatric Otolaryngology, Dhaka Shisu Hospital, Sher-e-Bangla Nagar, Dhaka. Thirty patients fulfilled the predefined eligibility criteria and were included in the study. Preoperative evaluation consisted of physical examination with regard to movement of the mass with protrusion of the tongue and ultrasonographic assessment of the mass. All the patients were operated by Sistrunk's approach and outcome was assessed in terms uneventful cure, infection and recurrence.&#x0D; Result: In the present study the children presented with TDC were on an average 7.1 (range: 3.5 - 11 years) years old and were predominantly girls (60%). Majority of patients belonged to middleclass (70%). Urban and rural representations were almost equal. Half of the patients were diagnosed between 5 - 10 years of age. Majority (80%) of the TDCs were located in infrahyoid region just lateral to the midline, 16.7% were located close to the hyoid bone (juxtahyoid) and 3.3% to the suprahyoid region in the midline. All the 30 cases presented with painless cystic swelling which moved upwards with protrusion of tongue. No signs of infection or associated diseases (myxoedema or thyroglossal fistula) were present. An anechoeic character with absence of fluid level was detected with ultrasono imaging of the mass.&#x0D; Conclusion: Clinical presentation and anatomical location and management were almost same as elsewhere in the world. But in the absence of a complete database including the follow up data, it is not feasible to plan for further improvement of the children with TDC.&#x0D; Ibrahim Cardiac Med J 2014; 4(2): 37-42

Effects of neuromuscular electrical stimulation combined with effortful swallowing on post‐stroke oropharyngeal dysphagia: a randomised controlled trial

Neuromuscular electrical stimulation (NMES) has been used as a therapeutic intervention for dysphagia. However, the therapeutic effects of NMES lack supporting evidence. In recent years, NMES combined with traditional swallowing therapy has been used to improve functional recovery in patients with post-stroke dysphagia. This study aimed to investigate the effects of effortful swallowing combined with neuromuscular electrical stimulation on hyoid bone movement and swallowing function in stroke patients. Fifty stroke patients with mild dysphagia who were able to swallow against the resistance applied by using NMES and cooperate actively in training were included. This study was designed as a 6-week single-blind, randomised, controlled study. In the experimental group, two pairs of electrodes were placed horizontally in the infrahyoid region to depress the hyoid bone. The NMES intensity was increased gradually until the participants felt a grabbing sensation in their neck and performed an effortful swallow during the stimulation. In the placebo group, the same procedure was followed except for the intensity, which was increased gradually until the participants felt an electrical sensation. All participants underwent this intervention for 30 min per session, 5 sessions per week, for 6 weeks. Videofluoroscopic swallowing studies (VFSS) were carried out before and after the intervention and kinematics of the hyoid bone and swallowing function were analysed based on the VFSS. The experimental group revealed a significant increase in anterior and superior hyoid bone movement and the pharyngeal phase of the swallowing function. This intervention can be used as a novel remedial approach in dysphagic stroke patients.

A cross sectional study of variations in the external carotid artery in cadavers

The External Carotid Artery supplies mostly the scalp, neck and face regions of the body. A detailed knowledge of blood vessels and nerves in this head, neck and face regions is very helpful in various therapeutic and diagnostic procedures such as surgical resection of head, neck, face and oral cancers, radical neck dissection, plastic and reconstructive surgeries related to this vital region. Cerebrovascular strokes due to atherosclerosis, haemorrhage or embolism require radiological investigation like carotid angiogram, surgical procedures like carotid endarterectomy also require a thourough knowledge of anatomy of external carotid artery and its branches. Anomalous branching pattern of the carotid arteries and variations in the relative position of internal and external carotid arteries can also damage cranial nerves related to them. Hence, it was decided to undertake a morphometric study of external carotid artery by meticulous dissection of cadavers. The aim was to study variations in the course, relations and branching pattern of External Carotid Artery. In this study, 60 cadavers embalmed with 10% formalin were used, and thus 120 neck-halves were studied. Of these cadavers 52 were male and 8 were female. These cadavers were obtained from the Department of Anatomy, Seth G.S. Medical College, Parel, Mumbai, Maharashtra. The present study was conducted over the period of two years. Linguofacial trunk was observed to be the commonest variation i.e. in 17 cases (28.33%) on the right side and in 18 cases (30%) on the left side. Thyrolinguofacial trunk was encountered in one case (1.67%) on the left side. Also Accessory branches of ECA such as branches to the parotid gland, submandibulargland, infrahyoid region and pharyngeal muscular branches were found in 6 cases (10%) on the right side and in 5 cases (8.33%) on the left side. Keywords: Thyrolinguofacial trunk, External carotid artery, Endarterectomy, Cerebrovascular strokes, Cadavers

Velar vocal folds are present in female and immature male koalas (Phascolarctos cinereus)

It was recently shown that adult male koalas (Phascolarctos cinereus) possess a novel vocal organ, the velar vocal folds, that underlie their mating bellows. Here we demonstrate through dissection of the infrahyoid region that this novel structure is also present in female and immature male koalas.

Cleidohyoideus Accessorius - Boyun Bölgesinde İlave İnfrahyoid Kası

Variations of the muscles in the infrahyoid region assume clinical significance during diagnostic and surgical procedures in the region of neck. Accessory muscles are rare anatomical variants which may have clinical implications. The present case reports the existence of an accessory muscle, the cleidohyoid. The muscle was unilaterally observed arising from the upper surface of the middle of the clavicle and inserting into the hyoid bone. The occurrence of this muscle in the densely packed region as in the neck may have functional, diagnostic, surgical and pathological implications.

Developmental anomalies of thyroid: Thyroglossal duct cyst associated with ectopic thyroid: Radiology and nuclear medicine imaging findings

We report a case of euthyroid young female with anterior midline neck swelling, non-tender gradually increased to present size since childhood. On anatomic cross sectional imaging ultrasonography (USG) and computed tomography (CT) scan showed multiseptated cyst in the midline neck, infrahyoid region with absent thyroid gland in its normal location suggestive of TGDC with absent normal thyroid gland. Thyroid scintigraphy study detects functioning thyroid tissue within the thyroglossal cyst and patent thyroglossal duct. F18-FDG PET/CT showed no uptake within the thyroglossal cyst and patent thyroglossal duct indicating no evidence of malignancy. This case highlights the role of nuclear medicine as a diagnostic challenging modality and thus aiding in therapeutic decision.

Radionuclide imaging of dual ectopic thyroid in a preadolescent girl.

Ectopic thyroid is a congenital defect in which the thyroid gland is located away from the usual pretracheal location. Dual ectopic thyroid, which consists of two foci of thyroid tissue, is very rare. In this case dual ectopic thyroid with subclinical hypothyroidism in a 10-year-old-girl was reported. The absence of the thyroid gland in the pretracheal location was revealed by ultrasonography (USG). Two foci of ectopic thyroid tissue located at the base of the tongue and infrahyoid region were determined by Technetium-99m pertechnetate thyroid scintigraphy. It can be concluded that if the thyroid gland is not visible by USG, ectopic thyroid tissue should be evaluated with scintigraphy.