A 20-year-old male presented with a midline soft tissue swelling in front of neck. On examination it is a cystic mass of 2 x 2 cm in size, which moves with deglutition and swallowing. No other significant finding observed. Which of the following is the definitive management for this condition:
Ans. D. Sistrunk's operationExplanationThe thyroid gland descends early in fetal life from the base of the tongue towards its position in the lower neck with the isthmus lying over the second and third tracheal rings.At the time of its descent, the hyoid bone has not been formed and the track of the descent of the thyroid gland is variable, passing in front, through or behind the eventual position of the hyoid body.Thyroglossal duct cysts represent a persistence of this track and may therefore be found anywhere in or adjacent to the midline from the tongue base to the thyroid isthmus.The cysts almost always arise in the midline but, when they are adjacent to the thyroid cartilage, they may lie slightly to one side of the midline. Classically, the cyst moves upwards on swallowing and with tongue protrusion.Thyroglossal cysts may become infected and rupture onto the skin of the neck presenting as a discharging sinus.Often occur in children, they may also present in adults, even as late as the sixth or seventh decade of life.TreatmentIncludes excision of the whole thyroglossal tract, which involves removal of the body of the hyoid bone and the suprahyoid tract through the tongue base to the vallecula at the site of the primitive foramen caecum, together with a core of tissue on either side (Sistrunk's operation).
Reassure the patient and regular follow-up
Surgical removal of cyst
Steroid injection into the cyst
Sistrunk's operation
Neck