What is a thyroglossal duct cyst?

When the thyroid gland is developing during embryological development, it starts out as a group of cells that are located at the base of the tongue in the back of the mouth. During embryological development, the thyroid cells move down a canal, called the thyroglossal duct, to the final location of the thyroid in the neck. Once the thyroid reaches its final location, the duct involutes, or disappears. If the duct does not fully disappear, portions of the duct can create pockets, called thyroglossal duct cysts. These pockets can fill with fluid or mucus.

Symptoms

Thyroglossal duct cysts often present as small, round or oval masses or lumps in the center of the front part of the neck. They usually appear in preschool-aged children through adolescence. They affect males and females equally. The cysts can become larger over time, especially in children with an upper respiratory infection. Sometimes large cysts can cause difficulty swallowing or breathing.

Thyroglossal duct cysts can become infected, causing redness and tenderness in the area of the cyst. Rarely, the cysts create sinuses, or openings, to the skin through which the cysts drain on their own. In these cases, children will have a small opening in their skin near the cyst which drains fluid or mucus. This is uncommon, and typically follows an episode of infection.

Evaluation and diagnosis

The diagnosis of a thyroglossal duct cyst is made by a health history and thorough physical exam. Your child will likely have an ultrasound to evaluate the mass.

Treatment

Thyroglossal duct cysts are typically removed through surgical excision. However, if the cyst is infected, a surgical procedure should not be done until the infection is treated. Removing an infected cyst without adequately treating the infection can result in a more difficult surgery. If your child has an infected thyroglossal duct cyst, antibiotics will be prescribed to treat the infection before moving forward with surgical excision.

Surgery to remove thyroglossal duct cyst

The surgical procedure to excise a thyroglossal duct cyst is called the Sistrunk procedure and is performed under general anesthesia. The procedure is usually a day surgery, meaning that your child will be able to go home the same day as the procedure.

A small incision is made over the cyst. The cyst and the entire tract are removed, as well as the middle portion of the hyoid bone, a small horseshoe-shaped bone that is found in the neck below the chin. It is important that the cyst and the attached tract are completely removed. If a portion is left, the cyst has a higher likelihood of recurrence, or coming back.

Any tissue that is removed will be sent to the pathology lab to confirm the diagnosis. The incision will be closed with dissolvable sutures with either DERMABOND (skin glue) or steri-strips on the skin.

DERMABOND is a sterile, liquid adhesive that will hold the edges of your child’s wound together and act as a waterproof dressing. It usually stays in place for 5-10 days before it starts to fall off. You should not pick, peel or rub the DERMABOND, as this could cause your child’s wound to open before it is healed.

Once it sets, the adhesive can get wet (as in a shower) the same day as the procedure, but should not routinely be submerged under water (as in swimming) for 5-10 days. Do not apply any ointments such as Vaseline or Neosporin to the incision while the DERMABOND is in place.

After surgery, your child will recover in the General Surgery recovery area until he or she is stable and able to swallow without difficulty. Your child will be sent home on oral pain medication.

Follow-up care

We will schedule your child for a follow-up appointment with the surgery clinic 2-4 weeks after the procedure. Recurrence rates after a Sistrunk procedure are low, but patients should be monitored to ensure the lesion does not return.

When to call the doctor

Please call the Division of Pediatric General, Thoracic and Fetal Surgery at 215-590-2730 if your child has any of the following symptoms:

• Fever (a temperature of 101.5 degrees or higher)
• Any signs of infection, including redness, swelling or pain
• Any drainage from the incision
• Any pain that is not controlled with the prescribed pain medicine
• A mass or lump in the center of the neck
• Any further questions or concerns