A 6-year-old boy is brought to his pediatrician with a 2-day history of fevers and cough. During the exam, the pediatrician notes a mass in the neck. His father first noticed it this morning. The mass is approximately 2 × 2 cm in size and located at the level of the hyoid in the midline of his neck (Figure 32-1). It is well circumscribed, with erythematous, and tender overlying skin. The mass moves when the boy swallows. The pediatrician suspects a thyroglossal duct cyst and refers to pediatric otolaryngology. The surgeon recommends complete excision to the father. After the upper respiratory infection has resolved, the thyroglossal duct cyst is removed completely under general anesthesia with no complications. The boy recovers completely.

Thyroglossal duct cyst is a congenital neck mass that occurs during development, as the thyroid descends from the base of the tongue to its paratracheal location.

Ectopic cervical thyroid.

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  It is reported that 7 percent of the population have thyroglossal duct cysts.¹

  
  
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  The most common congenital anomaly of the neck in children, representing more than 75 percent of congenital midline neck masses.²

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  Between the 3^rd and 4^th week of gestation, the thyroid gland descends from the base of tongue to its paratracheal location and remains connected by the thyroglossal duct, which involutes between the 7^th and 10^th week. Failure to involute results in persistence of a portion of this duct, which is known as a thyroglossal duct cyst.

  
  
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  Thyroglossal duct anomalies commonly present when they become acutely infected as a tender mass in the midline neck near the level of the hyoid. It is postulated that lymphoid tissue of the neck close to the thyroglossal structures reacts to repeated upper respiratory infections and this infectious irritation may stimulate epithelial remnants to undergo cystic change.³

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  There are no risk factors identified that predispose a child to acquiring this mass.

A good history of the present illness is paramount in the diagnosis and management of a neck mass. Important details include age that the mass was first noted, clinical signs, rate of growth and constitutional symptoms, recent travel outside of the US, and cat exposure.

Clinical Features

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  Typically presents after an upper respiratory infection as a painful, erythematous, and tender midline neck mass (Figures 32-1 and 32-2).

  
  
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  It can also appear as a mobile, painless mass in the midline of the neck.

  
  
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  Associated symptoms that may develop include fever, dysphagia, dysphonia, and/or a discharging sinus.

  
  
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  Average size is 2 to 4 cm in diameter.

  
  
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  Movement of the cyst with swallowing is often cited as a reliable diagnostic sign because of the thyroglossal duct’s close association with the hyoid bone and foramen cecum.⁴