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Thyroglossal Duct Cyst in Hyoid Bone: Unusual Location: The Journal of Laryngology & Otology

1. This case report describes an unusual location of a thyroglossal cyst within the hyoid bone in a 69-year-old woman. 2. Only two similar cases have been previously reported in the literature. 3. The cyst was excised from the hyoid bone and the thyroglossal duct was explored and removed. No recurrence occurred after surgery.

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48 views2 pages

Thyroglossal Duct Cyst in Hyoid Bone: Unusual Location: The Journal of Laryngology & Otology

1. This case report describes an unusual location of a thyroglossal cyst within the hyoid bone in a 69-year-old woman. 2. Only two similar cases have been previously reported in the literature. 3. The cyst was excised from the hyoid bone and the thyroglossal duct was explored and removed. No recurrence occurred after surgery.

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Tasia Rozakiah
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© © All Rights Reserved
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The Journal of Laryngology & Otology

August 2003, Vol. 117, pp. 656–657

Thyroglossal duct cyst in hyoid bone: unusual location


Abdullah Tas, Ahmet Rifat Karasalihoglu, Recep Yagiz, Latife DogÏ anay*, Selis Guven

Abstract
An atypically sited thyroglossal cyst in a 69-year-old woman is described in this report. The cysts may be located
in the intralingual, suprahyoid, thyrohyoid or suprasternal region. The intrahyoid location is rare. The diagnosis
was conŽrmed by computed tomography (CT). Surgical procedure should be indicated in intrahyoid
thyroglossal duct cyst cases.
Key words: Thyroglossal Duct Cyst; Hyoid Bone

Introduction
The thyroglossal duct cyst occurs as a dilated portion of the
thyroglossal duct. In 90 per cent of patients it is present in
the midline. It is most frequently found below the level of
the hyoid bone (85 per cent).1 A thyroglossal duct cyst
occurs when there is failure of obliteration of the
thyroglossal duct in the fetus during descent of the thyroid
from the tongue to its position in the neck. They may be
situated anywhere from the region of the foramen caecum
at the base of the tongue to the level suprasternal notch.2
Thyroglossal duct cysts occur mostly in children less than
10 years, but its appearance can be seen late through the
life.3 In the present case, the thyroglossal duct cyst was
located within the hyoid bone. A literature search revealed Fig. 1
that this intrahyoid location of a thyroglossal duct cyst is CT scans of the neck showing a cystic structure within the
rare. A case and a review of the literature regarding this hyoid bone.
unusual entity are presented.

Pathologic Žndings
Case report Histological examination of the cyst revealed three layers; an
Clinical data inner cyst wall, osseous plate in the middle, and Žbro-
muscular elements on the outside (Figure 2). The epithelial
A 69-year-old woman presented with a midline neck mass
lining of the cyst wall was predominantly ciliated respiratory
in the hyoid region. The mass, which had been present for
epithelium. Also, there was multilayered squamous epithe-
one year, had started to increase in size over the last three
lium. Well-vascularized connective tissue was seen under the
months. She did not complain of any pain or other
epithelial lining of the cyst wall. There were also inactive
symptoms. On examination, a 3.3 .5.cm swelling was
thyroid tissue and cholesterol granules in the cyst wall.
located in the anterior neck, at the level of the hyoid
bone. This mass was mobile with protrusion of the tongue
and not inŽltrated to the skin. There was no associated Discussion
cervical lymphadenopathy. Laboratory tests and a thyroid A thyroglossal duct cyst is the most common congenital
scan were normal. A CT scan of the neck showed a cystic neck mass, resulting from the persistence and dilatation of
structure within the hyoid bone (Figure 1). remnants of an epithelial tract formed during migration of
the thyroid during embryogenesis. Approximately seven
per cent of the population have thyroglossal duct
Treatment remnants. Although thyroglossal duct cysts generally
Under general anaesthesia the cystic lesion was excised present clinically in children, it is important to understand
from the hyoid bone. The thyroglossal duct was explored that the lesion can present in adults as well, sometimes
and was found to extend from the hyoid bone to the much later in life.4
thyroid isthmus. This duct was excised. Post-operative There are four general locations of the thyroglossal duct:
recovery was uneventful. No recurrence of the disease has intralingual (2.1 per cent); suprahyoid (24.1 per cent);
been seen for the past three months. thyrohyoid (60.9 per cent); and suprasternal (12.9 per

From the Departments of Otorhinolaryngology and Pathology*, Trakya University, Faculty of Medicine, Edirne, Turkey.
Accepted for publication: 28 May 2003.

656
clinical records 657

relationship to the hyoid bone so that it may not only be


anterior or posterior but may be present rarely within the
substance of the bone. This intrahyoid localization
supports the surgical approach of systematic resection of
the body of the hyoid bone in thyroglossal duct cyst cases.

x This is a case report of an atypical thyroglossal cyst


arising within the hyoid bone
x Two such cases have been previously reported
x The embryology of this finding is briefly discussed

References

Fig. 2 1 Montgomery WW. Surgery of the Upper Respiratory


System. Philadelphia: Lea and Febiger, 1973
Cyst wall at the inner (black arrow) bony plate (arrow head)
and fibromuscular tissue at the outer (white arrow) (H.&.E; 2 Montgomery WW. Block dissection of the neck. In: English
3 12.5). GM, ed. Otolaryngology. Philadelphia: 1985,5:1–35
3 Bourjat P, Cartier J, Woerther JP. Thyroglossal duct cyst in
hyoid bone: CT ConŽrmation. J Comput Assist Tomogr
cent).5 The forward growth of the hyoid bone explains the 1988;12:871–3
siphon-like winding of the thyroglossal tract around the 4 Ewing CA, Kornblut A, Greeley C, Manz H. Presentations
lower and posterior surfaces of the body of the hyoid bone. of thyroglossal duct cysts in adults. Eur Arch Otorhinolar-
According to other theories, however, the embryonic yngol 1999;256:136–8
thyroid can develop along a pre-, trans-, or retro-hyoid 5 Maran AGD. Benign disease of the neck. In: Kerr AG ed,
pathway. The intrahyoid location is explained by one of Scott-Brown’s Otolaryngology, 6th edn. Oxford: Butter-
the theories of the migration of the rudimentary thyroid worth-Heinemann, 1997;5:1–19
during embryogenesis. A retrohyoid and especially intra- 6 Podoshin L, Fradis M, Goldstein J, Misselevitch I, Boss JH.
hyoid localization is rare, and is usually considered as a Intrahyoid thyroglossal cyst. J Laryngol Otol
simple cyst attached to the periosteum. 3 In the present 1989;103:539–42
case, the thyroglossal duct cyst was located within the 7 Horisawa M, Sasaki J, Niinomi N, Yamamoto T, Ito T.
hyoid bone. Thyroglossal duct remnant penetrating the hyoid bone – A
This evidence was reported by two cases in the case report. J Pediatr Surg 1998;33:725–6
literature.3 ,6 These cases were 65- and 67-year-old 8 Sistrunk WE. The surgical treatment of the thyroglossal
women similar to our patient. Horisawa et al.7 reported tract. Ann Surg 1920;71:121–4
one case in a 59-year-old man, in which the thyroglossal 9 Ellis PDM, Van Nostrand AWP. The applied anatomy of
duct penetrated the hyoid bone. Sistrunk8 described the thyroglossal tract remnants. Laryngoscope 1977;87:765–70
thyroglossal ducts as usually passing through the hyoid
bone, although they are sometimes found to pass Address for correspondence:
anteriorly or posteriorly to the hyoid bone. Ellis and Van Dr Abdullah Tas,
Nostrand9 in 1977 re-introduced the theory that the Department of Otorhinolaryngology,
thyroglossal duct passes anteriorly to the hyoid bone. Faculty of Medicine, Trakya University,
Horisawa et al.7 found a thyroglossal duct passing Edirne, 22030,
anteriorly to the hyoid bone in 30 children with thyr- Turkey.
oglossal duct cysts. But they saw no instance of the
thyroglossal ducts passing through or posterior to the Fax: 1 90 284 235 27 30
hyoid bone. Thyroid tissue is present in the thyroglossal E-mail: [email protected]
duct cyst wall in more than 60 per cent of cases.5 In our
case, inactive thyroid tissue was observed.
Dr A. Tas takes responsibility for the integrity of the content
In conclusion, during migration of the thyroidal remnant
of the paper.
from the pharyngeal oor, the duct descends to the level of
Competing interests: None declared
the Žnal location of the thyroid gland. The duct varies in its

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