Midline Neck Research Articles

Thyroglossal Duct Fistula with an Unusual Presentation: A Case Report

Thyroglossal duct anomaly is one of the commonest congenital anomalies with midline neck manifestation. Though commonest location mentioned in the literature is thyrohyoid, several rare presentations have also been described. Here, we present a very rare case of thyroglossal fistula manifesting in submental region.

Thyroglossal Duct Fistula with an Unusual Presentation: A Case Report

Thyroglossal duct anomaly is one of the commonest congenital anomalies with midline neck manifestation. Though commonest location mentioned in the literature is thyrohyoid, several rare presentations have also been described. Here, we present a very rare case of thyroglossal fistula manifesting in submental region.

Midline Neck Swelling Mimicking Thyroglossal CystReport of an Uncommon Presentation of Cysticercous Infestation

Cysticercosis in humans is caused by an infestation by larvae of Taenia solium. The neck is a rare site of the infestation. Here, we present the case of cysticercosis situated in the neck of a 12-years-old child. The midline neck swelling present in the child since 2 years mimicked thyroglossal cyst, both clinically and radiologically. There were no other systemic complaints. Fine Needle Aspiration Cytology (FNAC) of the swelling was done for reaching the final diagnosis. Hence, in all inflammatory/cystic lesions, particularly in endemic areas, the possibility of cysticercosis should be taken into consideration irrespective of age, location, and the size of the lesion.

Tuberculosis thyroid with FNAC changes mimicking thyroid tumor

TB in India is extremely common especially in young and adults as compare to other age groups. It is more common in the female population in India where women remain poor and neglected. We present the case of a 35-year-old male who presented with a thyroid lump. On examination, there was a solitary, non-tender, and firm swelling on the left midline neck with no evidence of lymphadenopathy. Ultrasound of thyroid revealed multinodular goiter with the largest nodule (3.5 × 2 cm) in the right lobe of the thyroid. Ultrasound-guided FNAC revealed follicular cells on a background of lymphocytes making a diagnosis of thyroiditis and underwent hemithyroidectomy for the same.

Study of benign neck swellings of anterior neck triangle at a tertiary care centre

<p class="abstract"><strong>Background:</strong> Tumors of the neck are interesting to surgeons especially because of the complex neck anatomy and difficult differential diagnosis. The aim is to study different types of neck swellings i.e. thyroid swelling, salivary gland swelling, other neck swellings such as thyroglossal cyst, branchial cyst, lymphangioma and also the miscellaneous and rare lumps in the neck. The study also discusses their age and sex-wise distribution, clinical features, presentation, diagnostic modalities and treatment.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study, conducted at our institute Government Medical College, Latur from June 2017 to May 2018 for a duration of one year. </p><p class="abstract"><strong>Results:</strong> A total of 57 patients were studied during this period. Out of the 57 patients, 47 of them were midline swellings (82.45%) and 10 among them were lateral neck swellings (17.55%). People over a wide range of age group between 5-60 years were affected. Midline neck swelling were more common than lateral neck swellings.</p><p class="abstract"><strong>Conclusions:</strong> Among the midline benign neck swellings, thyroid swelling was found to be the commonest followed by thyroglossal cyst. Thyroid swellings occur more commonly in the females than males. Ultrasound guided FNAC is the most common, effective and safe investigation that aids in the diagnosis. Treatment of choice for benign, non-inflammatory and non-malignant neck swelling is mostly surgical excision rather than medical management.</p>

Thyroglossal duct cyst: myriad presentations

<p class="abstract"><strong>Background:</strong> Thyroglossal duct cysts are the most common midline neck swellings. They are routinely treated by surgeons with simple excision.</p><p class="abstract"><strong>Methods:</strong> We present a retrospective study of a series of 30 cases operated in our hospital over a period of five years and the challenges faced during investigations, surgery and postoperative period. All patients were clinically diagnosed as thyroglossal duct cysts. The diagnosis confirmed with USG Neck and FNAC of the swelling. CECT NECK was used to delineate the normal thyroid and patients were subjected to Sistrunk procedure under general anesthesia.</p><p class="abstract"><strong>Results:</strong> The outcome of all cases was good with one case being a revision surgery and another case going in for delayed healing due to infection. All patients were healthy with no complaints postoperatively.</p><p class="abstract"><strong>Conclusions:</strong> This study validates the Sistrunk surgery as the best method of excision to avoid recurrences. This article highlights the variant presentations of this cyst in our institution and the challenges we faced in diagnosis, during surgery and later as well.</p>

Hyoid Periosteum Sutures: A Modified Tissue-Preserving Hyoid Suspension Technique for Obstructive Sleep Apnea.

To present and assess a new, simple, conservative modification of hyoidthyroidpexy using 2 sutures between hyoid periosteum and thyroid lamina. Included patients had obstructive sleep apnea with apnea hypopnea index >20. Through a small midline neck incision, 2 Vicryl sutures were applied between the hyoid periosteum and thyroid cartilage. Infrahyoid and suprahyoid muscles were not traumatized. In 19 patients, the mean apnea hypopnea index significantly dropped (P < 0.0001) from 51.5 ± 11.9 preoperatively to 10.1 ± 4.9 postoperatively. The mean lowest oxygen saturation significantly increased from 79.2 ± 10.2 to 89.5 ± 8.1 (P = 0.0015). Moreover, Epworth sleepiness scale showed significant improvements (P < 0.0001) as its mean diminished from 13.8 ± 2.9 to 5.3 ± 2.9. The hyoid periosteum sutures technique (simple modification of hyoidthyroidpexy) is considered effective easily applicable, less costly with limited tissue dissection. It could be combined with other procedures in multilevel surgery for obstructive sleep apnea.

SUN-618 An Unusual Case of Papillary Thyroid Cancer within a Thyroglossal Duct Cyst

Background: During gestation, the thyroid gland arises from endodermal tissues, and starts at the foramen cecum, then descends into the neck through the thyroglossal duct, and disappears at 8-10 weeks of gestation. Thyroglossal duct cysts arise from incomplete obliteration of the thyroglossal duct, and may contain thyroid tissue. Although the incidence of thyroid cancer has been rising, it is still relatively uncommon compared to other cancers, with papillary thyroid carcinoma being the most common type. However, in rare cases, thyroid carcinoma can occur within the thyroglossal duct cyst. We present a rare case of a young female with papillary thyroid carcinoma within a thyroglossal duct cyst. Case Presentation: A 28-year old female noticed an enlarging midline neck mass over the course of 5 years. She was initially evaluated by otolaryngology. CT neck revealed a heterogeneous large midline neck mass, measuring 5.7 x 3.6 x 4.99cm, which was separate from the thyroid gland. Submandibular lymph nodes were also enlarged. Pathology of core tissue biopsy of the mass demonstrated papillary thyroid carcinoma. She underwent thyroglossal duct cyst resection and total thyroidectomy with neck dissection. Pathology report was positive for papillary thyroid carcinoma, arising from thyroglossal duct cyst measuring 4.2cm. Three out of 16 lymph nodes were positive for papillary thyroid carcinoma. Thyroid gland had no evidence of malignancy. Postoperatively, thyroid hormone suppression therapy was started and she was treated with radioactive iodine ablation. Discussion: Thyroglossal duct cysts are the most common abnormalities in thyroid gland development. They are usually managed with excision, specifically the Sistrunk procedure, where the cyst, along with the entire tract and part of the hyoid bone is excised. In rare cases, thyroid cancer can arise within the thyroglossal duct cyst. When this occurs, management can sometimes be controversial, as there are no specific guidelines, and severity of disease varies. It is important to recognize that evaluation of these type of patients should include the thyroid and regional lymph nodes, in order to ensure that the thyroglossal duct cyst carcinoma is primary, and not a metastasis from a primary thyroid carcinoma. In cases where the malignancy is confined to the cyst, the Sistrunk procedure alone can be done. If malignancy is found in the thyroid and regional lymph nodes, the Sistrunk procedure in addition to total thyroidectomy is completed, and then post-operative management is the same as for differentiated thyroid cancer including radioactive iodine ablation. References Pellegriti G, Lumera G, Malandrino P, et al., Thyroid Cancer in Thyroglossal Duct Cysts Requires a Specific Approach due to Its Unpredictable Extension, JCEM, Volume 98, Issue 2, 1 February 2013, Pages 458-465.

SUN-520 Brain Calcinosis Syndrome Manifesting as Cerebellar Ataxia in a Chronic Hypoparathyroid Patient

BACKGROUND Chronic hypoparathyroidism in adults is usually secondary to previous thyroid surgery and is characterized by low calcuim and inappropriately low circulating PTH levels. The clinical presentation of hypoparathyroidism can vary with the serum calcium levels and chronicity of hypocalcemia. Hypoparathyroidism can cause intracranial calcifications but extensive intracranial calcifications are rare. Brain calcinosis syndrome is defined as bilateral calcium accumulation in the brain parenchyma, most often within the basal ganglia. Such intracranial calcifications occur in 0.3-1.5% of patients with hypoparathyroidism, often detected incidentally. The mechanism of intracranial calcification is not completely understood. Its occurrence with hypocalcemia suggests that increased calcium-phosphorus complex formation plays a role. THE CASE A 63-year old female was admitted due to dizziness. She had a fall prior confinement due to loss of consciousness lasting for less than 5 minutes, however, recovered afterwards. No head injury was detected at the referring hospital. She is hypertensive with good BP control on Amlodipine 2.5 mg and Losartan 50 mg taken once daily. She had total thyroidectomy for colloid adenoma 20 years ago, prescribed with Levothyroxine 100 mcg once daily but taken with poor compliance. She had episodes of cold intolerance, hoarseness, and weight gain. On examination, she was conscious and coherent. Blood pressure was 95/60 mm Hg, heart rate of 67 beats per minute. A midline neck scar from previous surgery was visible, no palpable neck mass or lymph nodes. Notable on the neurological examination were positive Rhomberg test and dysmetria evaluated by finger-to-nose test. Chvostek’s and Trosseau’s signs were negative. Motor, sensory and cranial nerve functions were intact. Plain cranial CT scan showed extensive cranial calcifications on both basal ganglia, corona radiata, brainstem and cerebellum. Blood tests revealed low levels of ionized calcium (0.91 mmol/L; N 1.12-1.32 mmol/L)), intact PTH (0.51 pg/ml; N 15-65 pg/ml), and FT4 (5.54 pmol/L; N 12-22 pmol/L). TSH was elevated (32.85 uIU/ml; N 0.27- 4.2 uIU/ml). Calcium with active vitamin D and levothyroxine were given. Physical rehabilitation initiated. Patient was eventually discharged improved, with decreased dizziness. CONCLUSION Basal ganglia calcifications present with diverse manifestations and include seizures, mental deterioration and disorders of the cerebellar or extrapyramidal function. Treatment usually involves calcium and vitamin D supplementation. Marked clinical improvement usually results from treatment of hypoparathyroidism. Measurement and monitoring of serum calcium, phosphorus and intact PTH is warranted. REFERENCE: Ramen C. Basak. A Case Report of Basal Ganglia Calcification - A Rare Finding of Hypoparathyroidism. Oman Med J. 2009 Jul; 24(3): 220-222.

Preoperative ultrasound for the diagnosis of thyroglossal duct cysts: A validation study

ObjectivesTo evaluate the use of ultrasound to distinguish between thyroglossal duct cysts (TGDC) and dermoid cysts (DC) for surgical planning. To validate the SIST (septae + irregular wall + solid components = TGDC) scoring system proposed by Oyewumi et al. [1]. MethodsThis was a retrospective chart review of pediatric patients with midline neck masses who presented between the years of 2005 and 2014 and underwent preoperative ultrasound and surgical resection. Two pediatric radiologists blinded to diagnosis reviewed each US for 14 separate characteristics. According to the SIST scoring system, one point was given for each of the following: internal septae, irregular walls, and solid components. Results45 patients met inclusion criteria. Final pathologic diagnosis showed 29 patients had TGDC, 16 had DC. The majority of patients with both TGDC and DC earned SIST scores of 0. ConclusionWhile ultrasound remains a useful part of the work-up of lesions of the head and neck in children, this small retrospective study was not able to validate the previously proposed SIST scoring system None of the parameters discussed in the original paper was found to be a statistically significant determinant of TGDC.

Diagnostic Accuracy of Midline Pediatric Neck Masses.

To assess clinical evaluation, ultrasound, and previously published predictive score at preoperatively diagnosing midline neck masses and demographic or clinical associations that aid in differentiation of thyroglossal duct and dermoid cysts. Retrospective chart review. Tertiary care children's hospital. Patients <18 years undergoing primary midline neck mass surgery with histopathologic diagnosis of thyroglossal duct or dermoid cyst who had preoperative ultrasound performed were included. An electronic medical record query generated 142 patients whose histopathologic diagnosis was thyroglossal duct cysts (TGDCs) or dermoid cysts (DCs). Charts were reviewed for demographic and clinical features. A radiologist blindly reviewed patients' ultrasounds for SIST (septae + irregular walls + solid components = thyroglossal) score components. Each patient received 3 preoperative diagnoses: clinical, ultrasound, and SIST. Statistical analyses were conducted to determine association of demographic, clinical, or radiographic variables with diagnoses. Specificity, sensitivity, and predictive values were evaluated for each candidate diagnosis. There were 83 TGDCs and 59 DCs. Tenderness, infection history, depth relative to strap muscles, and SIST components were more common among TGDCs. Sensitivity and positive and negative predictive values surpassed 63% for each diagnostic modality. SIST score outperformed other diagnostic modalities with sensitivity, positive predictive value, and negative predictive value of 84%, 91%, and 81%, respectively. Clinical and ultrasound assessments were largely inconclusive for dermoid cysts, but SIST correctly identified 89% of DCs. SIST score was the most accurate predictor of pediatric midline neck masses. Clinical and radiographic findings may help guide preoperative diagnosis, although further evaluation is required to develop more efficacious diagnostic tools.

Congenital midline cervical cleft in a neonate born to diabetic mother – An unusual association

Congenital midline cervical cleft is a rare developmental anomaly of the neck region with only 200 cases reported till date. This case report highlights an unusual association of congenital midline cervical cleft and maternal diabetes. We report a neonate born to a mother with uncontrolled type 2 diabetes who presented with a midline neck lesion characterized by a proximal skin tag, middle mucosal surface and a distal blind sinus causing micro retrognathia with no other visible malformation. Most of the cases reported till date have a sporadic occurrence. This is the first possible report of this anomaly in a neonate of diabetic mother. This raises a possibility of being a part of diabetic embryopathy, however occurrence by chance cannot be completely ruled out.

Case of Papillary Carcinoma Arising from Thyroglossal Duct Cyst with Regional Lymph Node Metastasis

Carcinoma originating from a thyroglossal duct cyst is a rare entity that is often identified on postoperative histopathology after Sistrunk procedure. In this procedure the thyroglossal duct cyst along with the entire tract and some part of hyoid bone are excised to prevent recurrence. We present the case of a 39-year-old male with midline neck swelling who was preoperatively diagnosed of locally advanced papillary carcinoma originating in a submental thyroglossal duct cyst and the presence of cervical lymph node metastasis.

Dermoid Cyst of the Parotid Gland: A Rare Entity.

Dermoid cysts of the head and neck are a rare entity. These cysts are benign cystic malformations and histologically composed of tissues originating from ectoderm and mesoderm. Dermoid cysts usually presents as midline neck mass and rarely appear in lateral region. These are extremely rare in parotid gland, however should be considered as a differential in the list of parotid mass. There are a few cases published till date. Superficial parotidectomy is suggested as surgical treatment, however sometimes enucleation is also sufficient. There are only very few case reports published on dermoid cysts in parotid glands. We present a rare case of this entity and the challenges faced in making diagnosis with a short review of the literature.

Clinical experience of thyroglossal cyst management

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Thyroglossal cyst is a cystic swelling arising from embryological remnant of thyroglossal cyst. Cyst is typically located in the midline of the anterior neck and moves upward with tongue protrusion. The gold standard management for thyroglossal cyst is the Sistrunk procedure.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Total of 32 patients of all ages and both sexes operated at Sapthagiri Institute of Medical Science and Research Centre, Bangalore during the study duration were included a detailed history and thorough physical examination was done to arrive clinical diagnosis. Ultrasound studies and FNAC were done in all cases to confirm the clinical diagnosis of thyroglossal cyst. Management was mainly surgical and Sistrunk operation was done in all cases. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Thirty two patients of with the diagnosis of thyroglossal cyst were managed from 2011 to 2018 in the department of ENT, Sapthagiri Institute of Medical Science, Bangalore, 20 (62.5%) were females and 12 (37.5%) were males age ranged from 5 to 40 years; mean age was 16.5 years.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Thyroglossal cyst presents most commonly in paediatric age as cystic painless midline neck swelling. Diagnosis is made on clinical examination complimented with ultrasound and FNAC. Sistrunk operation is the treatment of choice to prevent recurrence and histopathological examination of the surgical specimen is must to rule out malignant transformation in the cyst.&lt;/p&gt;

Clinical Presentation of Thyroglossal Cyst and its Management Study of Two Hundred Cases

Objectives – To find out clinical presentation, management &amp; Complication of surgery of Thyroglossal cyst.Methods – It was a cross sectional study done in the Department of Otolaryngology and Head-Neck Surgery, BSMMU, DMCH &amp; RMCH, from January 2009 to June 2015. 200 Patients undergoing Sistrunk’s operation for cytologically proven Thyroglossal cyst were included in this study. Patients were reviewed after sugary and any complication that occurred were recorded. Results – Within 200 patients, most (34%) were in 1st decade, mean age19.17 years, male-female ratio 1.2 : 1, in 92.5% cases cyst in midline, Complication of surgical management in 8.5% cases and recurrence is 1.5% cases after Sistrunk’s operation.Conclusions – Thyroglossal cysts commonly present as midline neck swelling within 2nd decade of life and can be successfully treated with Sistrunk’s operation with minimal recurrence.TAJ 2012; 25: 26-29

Invasive primary papillary carcinoma in a thyroglossal duct cyst: A case report and review of the literature

PatientFemale, 46. Clinical procedureSistrunk's procedure, Total Thyroidectomy and excision of the cervical lymph nodes. BackgroundThyroglossal duct cyst is the commonest congenital anomaly of the thyroid gland. Occurrence of malignancy in a thyroglossal duct cyst is considered a rare condition, forming 1% of all cases of thyroglossal duct cyst. Here in the current report we presented a rare case of primary papillary carcinoma which arise in a thyroglossal duct cyst and a review of the literature. Case reportOur case is a 46-year-old female patient who presented with a painless cystic mass in front of the neck. After initial physical examination we have performed fine needle aspiration cytology (FNAC) of the cyst which revealed a papillary neoplasm. The patient underwent total thyroidectomy with excision of the cervical lymph nodes and surgical excision of the thyroglossal duct cyst (the Sistrunk's procedure). Histopathology of the specimen revealed a thyroglossal duct cyst which contains a primary invasive papillary carcinoma that infiltrated the cyst wall. The thyroid gland was normal, most of the cervical lymph node was positive for PTC. ConclusionsPrimary papillary carcinoma of thyroglossal duct cyst is a rare condition that should be considered in patients with cystic midline neck masses. Surgery and radical excision is the optimal patient management to improve survival.

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.

Thyroid abscess in a 5 year old child caused by Enterococcus species: a rare case report

&lt;p class="abstract"&gt;&lt;span lang="EN-IN"&gt;Thyroid abscess is a rare clinical entity which is attributable to its unique anatomical and physical characteristics which makes it resistant to infection. Thyroid gland is resistant to infection because of its rich blood supply and lymphatic drainage, an iodine rich environment and separation of the gland from other structures of neck by facial planes. In our case report, 5 years old male patient presented with a painful anterior midline neck swelling which was diagnosed as thyroid abscess caused by &lt;em&gt;Enterococcus&lt;/em&gt; species. The patient was successfully treated with surgical drainage and appropriate antibiotics&lt;/span&gt;&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;

Facial morphology and growth following surgery for congenital midline cervical cleft patients

Congenital midline cervical cleft (CMCC) is a rare condition that consists of a cutaneous midline neck lesion with a sinus extending inferiorly towards the sternum. A fibrous band that extends superiorly to the mandible is a consistent feature of the condition. Restriction of growth of the mandible, possibly due to incomplete removal of the band, is the most significant long-term problem. It remains unclear whether early removal of the fibrous band might allow catch-up growth of the mandible. This study utilized non-invasive three-dimensional photographs to objectively evaluate the facial growth of six CMCC patients. The growth of these CMCC patients was compared to the average growth of age- and sex-matched controls from a database of three-dimensional facial photographs of clinically normal subjects. After surgical removal of the fibrous cord, CMCC patients experience growth in the chin at the same rate as in the normal population; no evidence was found for catch-up growth. As a result, individuals with CMCC are likely to require further surgical intervention to correct the residual retrognathia on completion of facial growth. Early excision of the lesion including aggressive resection of the fibrous band is still recommended, as this should optimize the early growth of the mandible in infancy.