Remnants of embryonic branchial apparatus, Thyreoglossal duct cysts

definition remnants of embryonic branchial apparatus

clefts and pouches incompletely obliterated by mesenchyme, become neck masses, present as cysts, sinuses, fistulae or cartilaginous remnants

what is the most common presentation of remnants of embryonic branchial apparatus

complete fistulas

when do remnants of embryonic branchial apparatus present

at birth (congenital)

clinical aspects remnants of embryonic branchial apparatus

mucoid drainage from ext opening, infected fluid

treatment remnants of embryonic branchial apparatus

complete excision

• if infection, treat infection first

in which patients is thyreoglossal duct cysts

preschool kids

location and types of thyreoglossal duct cysts

according to position along migratory course of thyroglossal tract → intralingual, suprahyoid, thyrohyoid, suprasternal

clinical aspects thyreoglossal duct cysts

midline upper neck cystic mass, moving when swallowing or protrusion tongue, upper resp infection, compression on trachea/larynx, suppuration

associations with thyreoglossal duct cysts

thyroid ectopy and hypothyroidism

imaging modality for thyreoglossal duct cysts

CT with contrast is preferred(homogenous fluid attenuation surrounded by enhancing rim), MRI shows relationship to hyoid, US (well defined anechoic mass w/ post enhancement, if infection wall thick)

________ should always be assessed preop in all cases of thyreoglossal duct cysts

thyroid fxn

treatment thyreoglossal duct cysts

sistrunk procedure - resection cyst and hyoid

sclerotherapy - ethanol infection

why would sistrunk operation be repeated in thyreoglossal duct cysts

recurrence from arborization of sup. thyroglossal tract → do complete excision of thyroglossal duct tract up to tongue

what can enlarge thyreoglossal duct cysts

radiation