Thyroglossal Duct Cysts and Branchial Cleft Cysts

Head and neck masses are common in children.
Location of the mass is key to diagnosis.
Also it is important to determine if the lesion is solid or cystic.

DIFFERENTIAL DIAGNOSIS OF HEAD AND NECK MASSES IN CHILDREN (FIGURE 38.1)

Thyroglossal duct cyst
Branchial cleft cyst
Lymphatic malformation
Cervical bronchogenic cyst
Ectopic thyroid
Dermoid cyst

RELEVANT ANATOMY AND EMBRYOLOGY (FIGURE 38.2)

Most thyroglossal duct cysts are located close to the hyoid bone.
The thyroid gland derives from endoderm originating from the junction of the anterior two-thirds and posterior one-third of the tongue (foramen cecum).
The developing thyroid then descends through the developing hyoid bone and ultimately is located anterior to the third to firth tracheal cartilage.¹
A thyroglossal duct cyst is due to incomplete obliteration of the thyroglossal duct.
It is rarely seen off the midline.

EPIDEMIOLOGY

Most common midline surgical mass in childhood¹
Same occurrence in males and females

Figure 38.1 Head and neck congenital lesions seen in children in frontal and lateral views. The shaded areas denote the distribution in which a given lesion may be found: (A) dermoid cyst; (B) thyroglossal duct cyst; (C) second branchial cleft appendage; (D) second branchial cleft sinus; (E) second branchial cleft cyst; (F) first branchial pouch defect; and (G) preauricular sinus or appendage. (Reprinted with permission from Shaw KN, Bachur RG, eds. Fleisher & Ludwig’s Textbook of Pediatric Emergency Medicine. 7th ed. Philadelphia, PA: Wolters Kluwer; 2016.)

CLINICAL PRESENTATION

Usually a firm midline swelling/mass in the anterior neck in the midline, sometimes present after precedent upper respiratory infection (Figure 38.3)
May present with an acute infection, most commonly due to H. influenzae or S. aureus¹
May also present as a draining sinus
May move upward with swallowing and tongue protrusion because of its connection with the foramen cecum of the tongue (would not be seen with dermoid cysts or lymph nodes)

Figure 38.2 Thyroglossal duct vestiges. (Reprinted with permission from Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 8th ed. Philadelphia, PA: Wolters Kluwer; 2017.)

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