RESUMEN
Midline cervical swellings are a heterogeneous group of conditions in children. Careful clinical examination will allow a diagnosis to be made in many instances and appropriate investigations to be performed before referral to surgical services. The approach to clinical examination, investigation and management of the most common conditions is described.
Asunto(s)
Quiste Tirogloso/diagnóstico , Quiste Tirogloso/cirugía , Niño , Quiste Dermoide/diagnóstico , Diagnóstico Diferencial , Humanos , Linfadenopatía/diagnóstico , Cuello/patología , Ránula/diagnóstico , Quiste Tirogloso/embriología , Disgenesias Tiroideas/diagnósticoRESUMEN
The thyroglossal duct cyst (TGDC) is the most common developmental cyst of the neck. The cyst typically occurs along the midline of the neck on the ventral surface. Malignant transformation is rare and can be diagnosed only after histologic examination of a biopsy specimen. This article presents a brief, focused narrative review, which includes a discussion of successful treatment of a TGDC, and a single case report that describes a Sistrunk-like procedure.
Asunto(s)
Quiste Tirogloso , Adulto , Transformación Celular Neoplásica , Humanos , Masculino , Quiste Tirogloso/diagnóstico , Quiste Tirogloso/embriología , Quiste Tirogloso/patología , Quiste Tirogloso/cirugíaAsunto(s)
Carcinoma Basocelular/cirugía , Neoplasias Faciales/cirugía , Hiperpotasemia/sangre , Litotricia/efectos adversos , Neoplasias Cutáneas/cirugía , Quiste Tirogloso/diagnóstico , Adulto , Reacciones Falso Positivas , Humanos , Leucemia Linfocítica Crónica de Células B/sangre , Masculino , Cirugía de Mohs , Potasio/sangre , Manejo de Especímenes , Quiste Tirogloso/embriología , Tomografía Computarizada por Rayos XRESUMEN
To investigate developmental changes in the thyroglossal duct, we observed serial sagittal sections of eight embryos (crown-rump length (CRL) 6-12 mm; approximately 5-6 weeks of gestation) as well as serial horizontal or cross-sections of 70 embryos and fetuses (CRL 15-110 mm; 6-15 weeks). In the sagittal sections, the thyroglossal duct was identified as a small sheet or mass of relatively large cells with vacuolization anterior, superior or inferior to the fourth pharyngeal arch artery. However, we found no continuous duct-like structure that reached the thyroid gland. Thus, previous classical schemes might have overestimated the continuity of the duct. Among cross-sections of 70 specimens, we found the thyroglossal duct remnant in only two specimens (CRL 15 mm and 100 mm), in contrast to the pyramidal lobe, which was seen in one-third of the specimens. The duct remnant ran downward along the lateral edge of the hyoid body to reach the anterior aspect of the thyroid cartilage. However, the connection between the pyramidal lobe and the duct remnant was interrupted by the anterior cervical muscles. Therefore, it was unlikely that the thyroglossal duct remnant would more frequently be evident in fetuses than in adults. The highly tortuous course of the duct along the lingual aspect of the hyoid body, which has been reported previously, appeared to become established near term. Descent of the thyroid gland was not evident after the CRL 20 mm stage (6 weeks): the gland appeared to retain its position at the level of the third-sixth cervical vertebrae.
Asunto(s)
Feto/anatomía & histología , Quiste Tirogloso/embriología , Glándula Tiroides/embriología , Edad Gestacional , Humanos , Glándula Tiroides/cirugíaRESUMEN
Congenital cystic masses of the neck are uncommon and can present in any age group. Diagnosis of these lesions can be sometimes challenging. Many of these have characteristic locations and imaging findings. The most common of all congenital cystic neck masses is the thyroglossal duct cyst. The other congenital cystic neck masses are branchial cleft cyst, cystic hygroma (lymphangioma), cervical thymic and bronchogenic cysts, and the floor of the mouth lesions including dermoid and epidermoid cysts. In this review, we illustrate the common congenital cystic neck masses including embryology, clinical findings, imaging features, and histopathological findings.
Asunto(s)
Branquioma/patología , Quiste Dermoide/patología , Linfangioma Quístico/patología , Quiste Mediastínico/patología , Quiste Tirogloso/patología , Branquioma/congénito , Branquioma/embriología , Quiste Dermoide/congénito , Quiste Dermoide/embriología , Diagnóstico Diferencial , Diagnóstico por Imagen , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Linfangioma/patología , Linfangioma Quístico/congénito , Linfangioma Quístico/embriología , Masculino , Quiste Mediastínico/congénito , Quiste Mediastínico/embriología , Quiste Tirogloso/congénito , Quiste Tirogloso/embriologíaRESUMEN
Congenital cervical anomalies are essential to consider in the clinical assessment of head and neck masses in children and adults. These lesions can present as palpable cystic masses, infected masses, draining sinuses, or fistulae. Thyroglossal duct cysts are most common, followed by branchial cleft anomalies and dermoid cysts. Other lesions reviewed include median ectopic thyroid, cervical teratomas, and midline cervical clefts. Appropriate diagnosis and management of these lesions requires a thorough understanding of their embryology and anatomy. Correct diagnosis, resolution of infectious issues before definitive therapy, and complete surgical excision are imperative in the prevention of recurrence.
Asunto(s)
Branquioma/cirugía , Fístula/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Quiste Tirogloso/cirugía , Branquioma/congénito , Branquioma/diagnóstico , Branquioma/embriología , Niño , Quiste Dermoide/diagnóstico , Quiste Dermoide/cirugía , Fístula/congénito , Fístula/diagnóstico , Fístula/embriología , Neoplasias de Cabeza y Cuello/congénito , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/embriología , Humanos , Cuello/cirugía , Quiste Tirogloso/congénito , Quiste Tirogloso/diagnóstico , Quiste Tirogloso/embriologíaRESUMEN
Congenital neck lesions reflect abnormal embryogenesis in head and neck development. A thorough knowledge of embryology and anatomy is critical in the diagnosis and treatment of these lesions. The appropriate diagnosis of these lesions is necessary to provide appropriate treatment and long-term follow up, because some of these lesions may undergo malignant transformation or be harbingers of malignant disease.
Asunto(s)
Quistes/congénito , Neoplasias de Cabeza y Cuello/congénito , Cuello/cirugía , Región Branquial/embriología , Branquioma/congénito , Branquioma/embriología , Branquioma/patología , Quistes/embriología , Quistes/patología , Quiste Dermoide/congénito , Quiste Dermoide/embriología , Quiste Dermoide/patología , Quiste Epidérmico/congénito , Quiste Epidérmico/embriología , Quiste Epidérmico/patología , Neoplasias de Cabeza y Cuello/embriología , Neoplasias de Cabeza y Cuello/patología , Hemangioma/congénito , Hemangioma/embriología , Hemangioma/patología , Humanos , Enfermedades de la Laringe/congénito , Enfermedades de la Laringe/embriología , Enfermedades de la Laringe/patología , Linfangioma/congénito , Linfangioma/embriología , Linfangioma/patología , Ránula/congénito , Ránula/embriología , Ránula/patología , Teratoma/congénito , Teratoma/embriología , Teratoma/patología , Quiste Tirogloso/congénito , Quiste Tirogloso/embriología , Quiste Tirogloso/patologíaRESUMEN
An atypically located thyroglossal duct cyst in a 42-year-old man is described. A purely intralaryngeal thyroglossal duct cyst is extremely rare and can mimic other laryngeal lesions. This case demonstrates that thyroglossal duct cyst is a possible cause of intralaryngeal swellings and would have significant implications for the manner in which they are managed.
Asunto(s)
Laringe/patología , Quiste Tirogloso/diagnóstico , Quiste Tirogloso/cirugía , Adulto , Contraindicaciones , Humanos , Hueso Hioides/embriología , Hueso Hioides/cirugía , Laringoscopía , Laringe/cirugía , Masculino , Quiste Tirogloso/embriología , Glándula Tiroides/embriología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
During embryonic development the thyroid gland migrates through the thyroglossal duct from the pharyngeal endoderm to the anterior cervical region. The final step in this process is the total obliteration of the thyroglossal duct. A case is presented of a patient with a thyroglossal cyst together with a complete failure of the obliteration of the duct, which caused regurgitations of mucopurulent material after the expression of the cyst. This indicates a complete failure of the obliterative process. To the best of our knowledge, this phenomenon has not been described previously in the literature.
Asunto(s)
Hueso Frontal/diagnóstico por imagen , Hueso Frontal/patología , Quiste Tirogloso/patología , Adulto , Biopsia con Aguja , Hueso Frontal/embriología , Humanos , Masculino , Índice de Severidad de la Enfermedad , Quiste Tirogloso/diagnóstico por imagen , Quiste Tirogloso/embriología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Failure in regression of the thyroglossal duct is one of the most common reasons for midline swellings in the neck. Several authors have described recurrent thyroglossal duct remnants with persisting draining sinuses. However, few have described accessory salivary glands that drain into the thyroglossal duct. MATERIAL AND METHODS: In this article we report two such cases with midline salivary glands in the floor of the mouth. RESULTS: These two patients were subsequently successfully treated with radical tissue resection in the area between the hyoid bone and foramen cecum. INTERPRETATION: Preoperative fistulography or sinography was useful to demonstrate the ductal ramification of the salivary glands, and use of methylene blue during surgery proved of significant value for the result.
Asunto(s)
Glándulas Salivales , Quiste Tirogloso , Adolescente , Adulto , Femenino , Humanos , Masculino , Radiografía , Recurrencia , Glándulas Salivales/embriología , Glándulas Salivales/patología , Glándulas Salivales/cirugía , Quiste Tirogloso/diagnóstico por imagen , Quiste Tirogloso/embriología , Quiste Tirogloso/patología , Quiste Tirogloso/cirugíaRESUMEN
INTRODUCTION: Thyroglossal duct cyst (TGDcs) is the most common malformation of the neck. The risk of infection and malignant transformation impose its treatment. OBJECTIVES: The purpose of our study were: 1) to specify some points about the symptomatology and preoperative evaluation necessary for TGDcs diagnosis; 2) to analyse the factors who can explain an unsuccessful surgical treatment. PATIENTS AND METHODS: Our study is based on a retrospective review of cases and a review of the literature. From 1981 to 2000, 99 children with a mean age of five years were treated for a TGDcs with a surgical procedure in the Grenoble University Hospital. 3 excision and 96 Sistrunck's procedure were performed. In all cases a histological study was made. RESULTS: Ultrasonography was the most frequent preoperative evaluation. We have had 7 complications: 3 haematoma, 2 abscess and 2 desunited scar. 6 children have had recurrent disease. Among these 6 children, 3 have had an excision and 3 a Sistrunck's procedure. No case of malignant transformation was reported. CONCLUSION: Ultrasonography is the first preoperative evaluation to obtain before surgical treatment of a TGDcs. Sistrunck's procedure is the best surgical treatment with a value of recurrence from 1% to 10%. Areas of surgical failure included breaking of cyst during the dissection, inadequate hyoïd bone resection, an anatomical variation with many ductuli in the base of tongue, inadequate muscles of tongue resection.
Asunto(s)
Quiste Tirogloso/cirugía , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Factores Sexuales , Quiste Tirogloso/diagnóstico , Quiste Tirogloso/diagnóstico por imagen , Quiste Tirogloso/embriología , UltrasonografíaRESUMEN
The anatomic development of thyroglossal tract remnants is not understood at present. For analysis of morphology and growth patterns of thyroglossal tract remnants, we used histologic whole organ serial sections to determine developmental changes through the first years of life. Larynges of 58 infants and children ages 1 month to 13 years were obtained in whole organ serial step-sections in an axial plane. The slides were stained with hematoxylin and eosin, Alcian blue, and periodic acid-Schiff stains. Altogether, 3,247 histologic slices were examined. The resulting data were then correlated with the age and sex of the specimens. We found, in 24 cases (41.3%), remnants of the thyroglossal tract or ectopic thyroid tissue. In 4 specimens (16.6%), a complete thyroglossal tract could be observed that presented a ventral path in relation to the hyoid bone with no contact with the perichondrium of the cartilage. Hormonal activity of ectopic thyroid tissue was proven in 20 cases (34.5%). Thyroid follicles were located in 2 cases (3.5%) in the hyoid bone. The thyroglossal ducts revealed a modest tendency for a left-sided pathway, whereas thyroid follicles were located more on the right paramedian side. Morphometric data on the development and structure of the thyroglossal tract and the thyroid follicles during infancy and childhood are presented. The study provides quantitative data of clinical interest that elucidate the anatomy of thyroglossal tract remnants. In addition, our investigation supports Sistrunk's operative approach for avoiding recurrences in the treatment of thyroglossal duct cysts.
Asunto(s)
Región Branquial/embriología , Región Branquial/ultraestructura , Coristoma/embriología , Coristoma/patología , Hueso Hioides/embriología , Hueso Hioides/ultraestructura , Quiste Tirogloso/embriología , Quiste Tirogloso/ultraestructura , Enfermedades de la Tiroides/embriología , Enfermedades de la Tiroides/patología , Glándula Tiroides/embriología , Glándula Tiroides/ultraestructura , Distribución por Edad , Autopsia , Biopsia , Niño , Preescolar , Coristoma/cirugía , Femenino , Humanos , Lactante , Masculino , Distribución por Sexo , Quiste Tirogloso/congénito , Quiste Tirogloso/cirugía , Enfermedades de la Tiroides/cirugíaAsunto(s)
Fístula Cutánea/congénito , Fístula Cutánea/embriología , Quiste Epidérmico/congénito , Quiste Epidérmico/embriología , Cara/anomalías , Cara/embriología , Cuello/anomalías , Cuello/embriología , Quiste Tirogloso/congénito , Quiste Tirogloso/embriología , Fístula Cutánea/diagnóstico , Fístula Cutánea/cirugía , Diagnóstico Diferencial , Quiste Epidérmico/diagnóstico , Quiste Epidérmico/cirugía , Femenino , Edad Gestacional , Humanos , Recién Nacido , Masculino , Quiste Tirogloso/diagnóstico , Quiste Tirogloso/cirugíaAsunto(s)
Hueso Hioides/anomalías , Sinostosis/complicaciones , Sinostosis/diagnóstico , Quiste Tirogloso/diagnóstico , Quiste Tirogloso/cirugía , Cartílago Tiroides/anomalías , Adulto , Humanos , Hueso Hioides/embriología , Masculino , Quiste Tirogloso/complicaciones , Quiste Tirogloso/embriología , Cartílago Tiroides/embriología , Tomografía Computarizada por Rayos XRESUMEN
Commonly encountered head and neck lesions in children are described with an emphasis on evaluation, diagnosis, and treatment. Congenital lesions typically require excision, although hemangiomas usually resolve spontaneously. Acute suppurative lymphadenitis is common and readily diagnosed. Chronic lymphardenitis remains a diagnostic challenge and must be differentiated from malignancy. Lesions that do not respond to antibiotics should be biopsied to exclude neoplasms.
Asunto(s)
Neoplasias de Cabeza y Cuello/diagnóstico , Cabeza/anomalías , Linfangioma Quístico/diagnóstico , Cuello/anomalías , Branquioma/diagnóstico , Branquioma/terapia , Femenino , Neoplasias de Cabeza y Cuello/cirugía , Hemangioma/diagnóstico , Hemangioma/terapia , Humanos , Recién Nacido , Linfadenitis/diagnóstico , Linfadenitis/microbiología , Linfadenitis/terapia , Masculino , Infecciones por Mycobacterium , Quiste Tirogloso/diagnóstico , Quiste Tirogloso/embriología , Quiste Tirogloso/terapiaRESUMEN
A case of thyroid hemiagenesis discovered incidentally in a patient presenting with a thyroglossal duct cyst is reported. Thyroid embryology is briefly reviewed. Various characteristics of thyroid hemiagenesis and thyroglossal duct cysts are explored.
Asunto(s)
Quiste Tirogloso/complicaciones , Glándula Tiroides/anomalías , Humanos , Radioisótopos de Yodo , Masculino , Persona de Mediana Edad , Cintigrafía , Quiste Tirogloso/diagnóstico por imagen , Quiste Tirogloso/embriología , Glándula Tiroides/diagnóstico por imagen , Glándula Tiroides/embriologíaRESUMEN
We report a case of a partly ossified thyroglossal cyst in close proximity to the hyoid bone and discuss the possible embryological significance of this. Thyroglossal cysts occurring within the hyoid bone or deep to the hyoid periosteum support previous suggestions that the thyroglossal tract can sometimes be trapped within the developing hyoid bone.
Asunto(s)
Hueso Hioides/embriología , Osificación Heterotópica/patología , Quiste Tirogloso/embriología , Anciano , Anciano de 80 o más Años , Humanos , Hueso Hioides/patología , Masculino , Quiste Tirogloso/patologíaRESUMEN
Soft tissue cystic masses arising in the neck in children are commonly of embryologic origin and often surgically excised. Depending on location and histology, they can be classified as thyroglossal duct, branchial cleft, or rarely bronchogenic in origin. We present an unusual case of an infant with a lateral neck mass that communicates with the midtrachea. The histologic appearance is that of a combination of the features seen in cysts of branchial cleft and thyroglossal duct origin. The possible embryologic development of such a lesion is discussed.