Recently, Beibei's mother accidentally found that Beibei had a "pimple" in the middle of her neck, no pain or itching, no redness and swelling, moving up and down when swallowing, but did not affect eating, breathing, in order to know what the problem was, took Beibei to the Otolaryngology-Head and Neck Surgery Clinic of Jiangxi Hospital, Children's Hospital Affiliated to Chongqing Medical University, and the doctor considered this "pimple" as "thyroid tongue cyst" after careful examination and questioning.
What is a thyroid duct cyst?
Thyroid duct cyst is a congenital disorder that is a cystic mass left over from undegenerated or incomplete thyroid duct in the early embryonic period, which can occur anywhere on the midline of the neck from the blind tongue foramen to the upper edge of the sternum stalk, most commonly near the hyoid bone. It often occurs in children and adolescents. A small number of them are asymptomatic or slow to increase, and are not found until middle and old age.
What causes thyroid duct cysts?
The normal thyroid tongue canal is located in front of the hyoid bone, with a diameter of 1-2 mm, is closely connected to the front of the hyoid bone, and cannot be separated. It begins in the 4th week of embryo, the endoderm between the first pair of pharyngeal sacs and the ventral side of the pharyngeal cavity falls downward, forming a diverticulicular structure, that is, the base of the thyroid gland, called the thyroid tongue canal, which then extends to the interstitium below, and expands to both sides in front of the median trachea of the neck, forming two lateral lobes of the thyroid gland; At the 6th week of the embryo, the thyroid tongue tube degenerates on its own, leaving only a shallow depression, the tongue blind foramen, at its beginning. If, for some reason, the thyroid tongue canal does not degenerate or is incomplete after week 10, the remaining tubular structure accumulates due to epithelial secretions, and a thyroid duct cyst can form in the stroke from the base of the anterior median tongue to the thyroid gland, and the cyst can communicate with the tongue blind foramen through the undegenerated thyroid tongue canal.
What are the manifestations of thyroid duct cysts?
Thyroid duct cysts are mainly manifested by a round mass in the middle of the neck, which is elastic to the touch and can move up and down with swallowing or telescopic tongue. Infection may occur with an enlarged mass, redness, pain, and even abscess formation. When cystic secretions are retained or complicated by infection, fistulas may form after rupture.
If left untreated, the cyst can grow over time, forming a bulge in the neck. If it is located near the blind hole of the tongue, it can also affect swallowing, breathing and language function when it grows to a certain extent. Thyroid duct cysts also have a certain chance of becoming cancerous.
Infection of thyroid duct cyst
Thyrolingual cystic fistula
Thyroid duct cyst typing?
1. According to the fistula walking and the relationship with the hyoid bone during the operation, the classification (as shown in the figure below):
2. According to the scope of intraoperative Meilang staining and the pathological section analysis during and after surgery, thyroid tongue duct cysts can be divided into 5 categories:
Type I: subhyoid cyst or reticular fistula branching, a single fistula on the hyoid bone;
Type II: cysts or reticular fistula branches above and below the hyoid bone;
Type III: suprahyoid cyst or reticular fistula branching, subhyoid single fistula;
Type IV: subhyoid cyst or reticular fistula branching, suprahyoid fistula closure;
Type V: supracracicular cyst or reticular fistula branching subhyoid fistula atresia.
Will it be good to take medicine? How is it treated?
Taking medicine is not a complete cure. Thyroid duct cysts should be surgically removed before infection occurs after diagnosis to prevent infection, fistula, or cancer. Patients with concomitant infection should have elective surgery after infection control. Complete removal of cysts and fistulas is the mainstay of treatment for radical thyroid duct cysts.
Thyroid duct cysts are caused by developmental defects, and there is currently no specific and effective prevention method. It is necessary to do a good job of self-examination and regular physical examination, so as to achieve early detection, early diagnosis and early treatment. Patients who have developed thyroid duct cyst should avoid pharyngeal irritation as much as possible in daily life, and feel uncomfortable with early medical treatment. (Xiong Wenwen)