Thyroglossal cyst excision

Gnana Deepika1*, Deepapriya.R2, Dhariniya3, Ruby Ravichandran4

1Staff Nurse, OT, Maa Kauvery , Trichy, Tamil Nadu

2Incharge, OT, Maa Kauvery, Trichy, Tamil Nadu

3Nursing Educator, Maa Kauvery , Trichy, Tamil Nadu

4Senior Deputy Nursing Superintendent, Maa Kauvery, Trichy, Tamil Nadu

*Correspondence

Abstract

A Thyroglossal cyst excision is a surgical procedure to remove a thyroglossal duct cyst which is a congenital fluid filled cyst that develops from remands of the thyroglossal duct. It typically appears as a painless lump in the middle of the neck and may become infected or enlarge over time. This case report describes a 4 year old year female child presenting with midline neck swelling for two months, not associated with pain and discharge, that moves with protrusion of tongue. Clinical evaluation, laboratory investigation, USG neck are done to confirm thyroglossal cyst. The patient underwent successful surgical removal of the cyst followed by post-operative nursing care. This case emphasizes prevention  of wound infection by effective nursing care.

Key words: Thyroglossal cyst; Cyst – Fluid filled mass; Excision-The surgical removal of tissue, An organ or a growth from the body.

Introduction

A thyroglossal cyst excision is a surgical procedure performed to remove a thyroglossal duct cyst which is the most common congenital neck cyst. It develops when the thyroglossal duct an embryological structure that normally disappears before birth fails to close completely. The remaining duct can form a fluid filled cyst anywhere along the path from the base of the tongue to the thyroid gland most commonly in the midline of the neck. Patients typically present with a painless, movable neck swelling that elevates during swallowing or tongue protrusion, although infection may cause pain, redness, and difficulty swallowing.

The standard treatment is surgical removal using the Sistrunk-procedure, which involves excision of the cyst, central portion of the hyoid bone and the entire thyroglossal tract to reduce the risk of recurrence. Complete removal is important because simple cyst excision alone has a significantly higher recurrence rate. Preoperative evaluation usually includes clinical examination, imaging such as ultrasound and confirmation that a normally functioning thyroid gland is present. Proper surgical technique and post-operative care help minimize these risk and ensure favorable outcomes.

Case Presentation

4 years aged female child, presented with complaints of midline neck swelling since two months. There was no pain or any discharge.

Clinical findings: On clinical examination, the child had a midline neck swelling that moved with protrusion of tongue. These features led to the child being diagnosed as Thyroglossal cyst.

Investigation and results

Laboratory and diagnostic investigations were performed to assess the condition.

Radiological examination of neck: The findings midline hypoechoic focal lesion at the level of hyoid bone –F/C/O Thyroglossal cyst and bilateral reactive submandibular lymphadenopathy.

Laboratory investigation: The investigations showed that CBC –Hb-12.4g/dl, PCV-34.7% RBC-4.32, WBC-10640cells/cumm, platelets-447000cells/l.

Diagnosis

Based on clinical examination, history, symptoms and investigation findings thyroglossal cyst was diagnosed. The complaints of midline neck swelling and movement with protrusion of tongue also helped diagnose this condition.

Intra operative management

The patient underwent surgical removal of the cyst on 21/05/2026 under General anesthesia. The surgical findings include patient parts painted and draped. Head extended with headring and shoulder support. Incision placed inferior to the swelling. Incision deepened and the swelling was found to be having pultaceous material. Swelling delineated and excised in to, wound closed in layers. Hemostasis secured. Sterile dressing placed.

Post-operative management

Post-operative management in the post operative ward continuous monitoring of oxygen saturation, heart rate and vital signs. IV fluids, DNS 54ml/hr., Analgesics like INJ.PARACETAMOL 25ML IV TDS, antibiotics INJ. CEFOTAXIME 800MG were administered.

Outcome

The patient improved gradually following surgery and maintained normal thyroid function. There was no immediate postoperative complication such as wound infection and hematoma. The child responded well supportive care and medication.

Discharge

Before discharge, the child was stable, and there is no infection in the surgical site, normal thyroid function. Parents were educated regarding wound care, avoid heavy lifting, vigorous neck movement, and soft diet and importance of follow-up. To explain about the complications such as recurrence of thyroglossal cyst, scar formation, persistent sinus or fistula and neck stiffness.

Conclusion

The excision of a thyroglossal cyst, typically performed using the sistrunk procedure, is a safe and effective treatment that provide excellent outcomes with a low risk of recurrence when the cyst, tract and central portion of the hyoid bone are completely removed. The procedure relieves symptoms such as recurrent swelling, infection and discomfort while minimizing the chance of future complication. Careful surgical technique, appropriate postoperative care, and regular follow-up contribute to successful healing and recovery. Overall thyroglosal cyst excision remains the gold standard for definitive management, offering both functional and cosmetic benefits with a high rate of patient satisfaction.

References

  • Lewis SL, Bucher L, Heitkemper MM, Harding MM. Medical Surgical Nursing: Assessment and management of clinical problems, 11th edition, St. Louis: Elseiver; 2023.

Mondin V, Ferlito A, Muzzi E, Silver CE, Fagan JJ, Devaney KO, et al. Thyroglossal duct cyst: personal experience and literature review. Auris Nasus Larynx. 2008;35(1):11-25.

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