A CASE OF CYSTIC MIDLINE NECK SWELLING
 

CASE REPORT

n      20 year old male

n      Swelling since 10 years

n      Painless, slowly increasing in size.

• No other ENT/General symptoms

n      O/E: 5×3 cm, soft, cystic, non tender, fluctuant,non transilluminant & superficial to mylohyoid muscle. No movement with deglutition & tongue protrusion.

n      Oral cavity: No bulge in the floor of the mouth.

n      Rest of ENT examination: Normal.

INVESTIGATIONS

n      Routine Blood & Urine: Normal.

n      F.N.A.C: Inconclusive.

CLINICAL DIAGNOSIS

n      Sub Lingual Dermoid

n      Thyroglossal Cyst

n      Ranula

TREATMENT

n      Excision under LA.

n      External approach.

n      Swelling was well encapsulated & part of the swelling was found extending deep to mylohyoid.

n      No tract/attachment to hyoid.

HISTOPATHOLOGY

n      To our surprise, the HPE report was suggestive of Thyroglossal cyst.

 D/D FOR MIDLINE NECK SWELLINGS

n      Ludwig's Angina.

n      Sub mental Lymphadenitis.

n      Sublingual Dermoid.

n      Lipoma in the sub mental region.

n      Sub hyoid bursitis.

n      Thyroglossal cyst.

n      Thyroid nodule on the isthmus.

n      Pretracheal & prelaryngeal lymphadenitis.

n      Suprasternal space swellings.

n      Retrosternal goitre.

n      Thymus swelling.

SUB-LINGUAL DERMOID

n      Sequestration dermoid, often bigerminal.

n      Congenital but seen between 10-20 years.

n      7% of the Dermoids are seen in H&N of which only 6.5% are sublingual.

n      Derived from the entrapment & subsequent growth of epithelial cells during the midline fusion between the 1st & 2nd branchial arches in 3rd & 4th week of embryonic life.

SUB LINGUAL DERMOID

n      Lined by squamous epithelium with skin appendages, contains thick cheesy sebaceous material but no hair.

n      D/D: Ranula,Cystic hygroma,Thyroglossal cyst & branchial cleft cyst.

n      Treatment is excision by intraoral/external approach.

THYROGLOSSAL CYST

n      Commonest congenital neck mass in children.

n      A tubuloembryonic dermoid arising from thyroglossal tract/duct.

n      Age:15-30 years

n      90% in the midline.10% to one side of which 95% are to left, over the thyroid cartilage.

n      60.9% are subhyoid.24.1% supra hyoid,12.9% sublingual & 2.1% are intra lingual.

THYROGLOSSAL CYST

n      Thyroid tissue found in cyst wall in 45-60%.

n      Often asymptomatic.

n      Soft,cystic,fluctuation+/-.transillumination-

n      Moves with swallowing & tongue protrusion

n      Get Thyroid scan before excision.

n      Sistrunk`s operation is the surgery of choice

n      Chances of recurrence: 4-10%

MORE INFORMATION