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BRIEF CLINICAL STUDIES

Treatment of Large Thyroglossal

Duct Cyst
Germano de Lelis Bezerra Júnior, DDS,
Leonardo de Freitas Silva, DDS,y
Gabriel Gomes Pimentel, DDS,z
José Rodrigues Laureano Filho, PhD,§ and
Renato Luiz Maia Nogueira, PhDjj

Abstract: The thyroglossal duct cyst is the neck congenital

abnormality most common in the childhood. Clinically, it shows
itself as a solitary neck mass in the region of hyoid bone, it is
painless and can be dislocated during de physical examination and
tongue protrusion. The most common treatment is its removal
through the Sistrunk technique. Patient with diagnosis of thyro-
glossal duct cyst in neck region with extension to the mouth floor
was treated by total surgical removal through intraoral access. The
intraoral approach to the treatment of the thyroglossal duct cyst
showed itself practicable and permitted the total removal of the
lesion with no recurrence signs.

Key Words: Congenital abnormalities, head and neck neoplasms,

pediatric dentistry, thyroglossal cyst, thyroid gland FIGURE 1. Patient showing swelling in the submental region in (A);
computerized tomography scan showing the trachea deviation toward the
right side due to the lesion in (B); swelling in mouth floor with elevation and

T he thyroglossal duct cysts are usual in children and adolescents,

but, since they are frequently asymptomatic, they are normally
diagnosed at the age of 20 or older.1 This lesion normally shows
retroposition of the tongue in (C); view of the surgical site before removal of the
lesion in (D).

itself as a painless mass on the neck middle line, on the hyoid region
or slightly below it, and it can also be found on the thyroid duct performed without removal of the middle portion of the hyoid bone
embryological course.2 (Fig. 2A and B). A Penrose drain was put into surgical site through a
A 7-year-old patient, male, white, attended to the oral surgery little incision on skin of submental region, and was kept for
service complaining of dysphagia and dysphonia and showing 48 hours.
swelling on mouth floor with 6 years of evolution. During the Pathologic examination of the surgical specimen revealed cystic
clinical examination, it could be observed asymmetry of the lower capsule fragments lined by pseudostratified ciliated columnar
third of face, with a mobile mass in submandibular, sublingual, and showing squamous cell hyperplasia foci, and stratified epithelium
submental regions on the left side. The tongue was elevated (Fig. 1A
and C). The computerized tomographic scan revealed an extensive
lesion in neck region, which promoted the narrowing of the trachea
and its dislocation to the right side (Fig. 1B). The patient was
undergone to the incisional biopsy that indicated thyroglossal
duct cyst.
As a treatment form, it was performed a horizontal incision on
mouth floor between the Wharton duct outlet and womb of the
tongue, after that, the divulsion of muscle planes was carried out for
the exposition of the lesion (Fig. 1D). The removal of the lesion was

From the University of the State of Pernambuco FOP-UPE, Camaragibe,

PE; yUniversity of the State of São Paulo FOA-UNESP, Araçatuba;
zBatista Memorial Hospital, Fortaleza; §Maxillofacial Surgery and
Traumatology Course, State University of Pernambuco—FOP/UPE,
Camaragibe; and jjCourses Stomatology and Maxillofacial Surgery of
Federal University of Ceará- FFOE-UFC, Fortaleza, Brazil.
Received March 23, 2016.
Accepted for publication April 17, 2016.
Address correspondence and reprint requests to Leonardo de Freitas Silva,
DDS, José Bonifácio Street, Number 1193, Vila Mendonça, 16015-
050—Araçatuba, São Paulo, Brazil;
E-mail: leonardofreitas86@gmail.com
The authors report no conflicts of interest.
Copyright # 2016 by Mutaz B. Habal, MD FIGURE 2. View of the surgical site after removal of the lesion in (A); removed
ISSN: 1049-2275 lesion in (B); clinical aspects after 03 years of postoperative follow-up in (C)
DOI: 10.1097/SCS.0000000000002915 and (D).

The Journal of Craniofacial Surgery  Volume 00, Number 00, Month 2016 1
Copyright © 2016 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
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SCS-16-0460

Brief Clinical Studies The Journal of Craniofacial Surgery  Volume 00, Number 00, Month 2016

areas not keratinized, agreeing with the diagnosis of thyroglossal
duct cyst. Currently, 03-year follow-up patient showed no recur-
rence signs or functional and aesthetic complaints (Fig. 2C and D).
Nakayam et al3 reported 2 patients of thyroglossal duct cyst in
floor mouth region.3 The patients were treated by intraoral approach
with no complications.3 According to the study performed by
Tristan et al2 a recurrence rate of 4.5% was seen during a fol-
low-up period varying between 7 months and 10 years.2 In the
reported patient, it was not chosen the Sistrunk technique due to the
lesion location; alternatively, the intraoral approach has shown
itself practicable and, so far there have been no signs of recurrence.
The most usual treatment for thyroglossal duct cyst has been the
Sistrunk technique, but for the especial patients, as the reported one,
the intraoral approach has shown to be technically feasible and has
permitted the complete removal of the lesion with no signs of
recurrence until this moment. However, a longer follow-up period is
necessary to indicate patient’s cure.
REFERENCES
1. Gioacchini FM, Alicandri-Ciufelli M, Kaleci S, et al. Clinical
presentation and treatment outcomes of thyroglossal duct cysts: a
systematic review. Int J Oral Maxillofac Surg 2015;44:119–126
2. de Tristan J, Zenk J, Künzel J, Psychogios G, Iro H. Thyroglossal duct
cysts: 20 years’ experience (1992–2011). Eur Arch Otorhinolaryngol
2014;272:2513–2519
3. Nakayam S, Kimachi K, Nakayama K, et al. Thyroglossal duct cyst
occurring in the floor of the mouth: report of 2 cases. J Oral Maxillofac
Surg 2009;67:2690–2693

2 # 2016 Mutaz B. Habal, MD

Copyright © 2016 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.