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A case of cystic midline neck swelling

Published by : ayurdoctor on:09-10-13 03:02 PM


Case Report

  • 20 year old male

  • Swelling since 10 years

  • Painless, slowly increasing in size.


No other ENT/General symptoms

  • O/E: 5x3 cm, soft, cystic, non tender, fluctuant,non transilluminant & superficial to mylohyoid muscle. No movement with deglutition & tongue protrusion.

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

  • Rest of ENT examination: Normal.

  

Investigations

  • Routine Blood & Urine: Normal.

  • F.N.A.C: Inconclusive.


Clinical Diagnosis

  • Sub Lingual Dermoid

  • Thyroglossal Cyst

  • Ranula


Treatment

  • Excision under LA.

  • External approach.

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

  • No tract/attachment to hyoid.




Histopathology

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


D/D for midline neck swellings 

  • Ludwig's Angina.

  • Sub mental Lymphadenitis.

  • Sublingual Dermoid.

  • Lipoma in the sub mental region.

  • Sub hyoid bursitis.

  • Thyroglossal cyst.

  • Thyroid nodule on the isthmus.

  • Pretracheal & prelaryngeal lymphadenitis.

  • Suprasternal space swellings.

  • Retrosternal goitre.

  • Thymus swelling.


Sub Lingual Dermoid

  • Sub Lingual Dermoid

  • Sequestration dermoid, often bigerminal.

  • Congenital but seen between 10-20 years.

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

  • 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

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

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

  • Treatment is excision by intraoral/external approach.


Thyroglossal Cyst

  • Commonest congenital neck mass in children.

  • A tubuloembryonic dermoid arising from thyroglossal tract/duct.

  • Age:15-30 years

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

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


Thyroglossal Cyst

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

  • Often asymptomatic.

  • Soft,cystic,fluctuation+/-transillumination

  • Moves with swallowing & tongue protrusion

  • Get Thyroid scan before excision.

  • Sistrunk`s operation is the surgery of choice

  • Chances of recurrence: 4-10%

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