484 - LINGUAL THYROGLOSSAL DUCT CYST IN A NEONATE
Thyroglossal duct cyst (TGDC)are rare but most common cause for congenital neck masses. Antenatal diagnosis of TGDC is possible and airway obstruction at birth or in early infancy can be anticipated.
Case Report TGDC
A 20 day old term male neonate presented with stridor since birth and progressively increased over days. Antenatal ultrasonography in 3rd trimester had shown a cyst at the base of the tongue measuring 1.1x1.0x1.0 cm (volume 0.67cc). The findings were confirmed with CT scan after birth(Figure 1). Thyroid position and functions were normal. Direct laryngoscopy was done under general anesthesia before surgery(Figure 2). 1.5 ml of mucoid fluid was aspirated to decompress the cyst. Marsupialization and bipolar coagulation of cyst wall done and 0.5 ml Bleomycin was injected at base. Post-operatively baby was electively ventilated for two days. Histopathological examination of cyst wall was suggestive of TGDC (Figure 3). Follow-up scans showed complete resolution with no recurrence.
Figure 1: CT scan Saggital and Coronal View showing cyst within base of tongue.
Figure 2: Direct Laryngoscopy view before surgery showing cyst*
Figure 3: Histopathological image of cyst showing pseudostratified columnar epithelium
Lingual TGDC is a rare cause of stridor in neonates often misdiagnosed as laryngomalacia. Endoscopic marsupialization is the treatment of choice. Recurrence is rare.
The diagnosis of TGDC should be kept in mind in a neonate with stridor or acute airway obstruction.Surgical excision by intra-oral approach is suitable for management of pure lingual TGDC with Sistrunk’s procedure being reserved for those that extend into the neck.