A 25 years old male patient presents to the outpatient department with a midline swelling in the neck. O/E there is no movement of the swelling on swallowing, but the swelling moves on protrusion of the tongue. The likely origin of the swelling is
Answer: d) Midline endoderm of pharynxTHYROGLOSSAL CYSTArise from the midline endoderm of pharynxMost common site is the sub-hyoid regionMidline swelling (except in the region of thyroid cartilage where it is pushed usually to the left side)Congenital but swelling presents at the age of 15-30 yrsThyroglossal fistula is always acquiredCyst can be moved sideways but not up and downMoves up with the protrusion of tongue; moves with deglutitionRarely papillary carcinoma may developSurgery - Sistrunk operation (removal of the cyst + track + central part of hyoid bone + portion of the tongue base up to the foramen cecum
1st & 2nd branchial arch
4th branchial pouch
4th branchial arch
Midline endoderm of pharynx
Neck