Ultrasound imaging of thyroglossal cysts of the neck to the hyoid bone

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Юнусова L., Аояма T., Икрамов G., Халманов B., Сакамото J., & Курбанбаева H. (2021). Ultrasound imaging of thyroglossal cysts of the neck to the hyoid bone. in Library, 21(1), 30–33. извлечено от https://inlibrary.uz/index.php/archive/article/view/14140
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Аннотация

Background: The present study attempted to clarify the typical anatomical variants of Thyroglossal cysts (TGC). Patients and methods: Clinically and epidemiologically 67 previously non-experienced patients with TGC 1.5 to 73.0 years old were examined. Results: Based on clinical and ultrasound examinations of 121 patients with 67 thyroglossal cysts, the most typical cyst of anatomical variations was specified. It was noted that, concerning the hyoid bone, thyroglossal cysts may be suprahyoid (located at the root of the tongue), parahyoid (broadly adjoining the hyoid), prelingual (located in the front of the hyoid in the hypo lingual region), postlingual (located behind the hyoid bone in the prenatal and peri-laryngeal spaces), or sublingual (located the book from the hyoid bone). An ultrasound examination facilitated the identification of thyroglossal cysts with-out clinical manifestations (23 sublingual cysts among 37 [62.2%] were incidentally revealed by the ultrasound examination), which is important when selecting the most appropriate surgical treatment. Conclusion: Ultrasound studies facilitate the identification of TGCs located at the root of the tongue without any clinical manifestations, which is important when determining the degree of surgical treatment to perform.

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Annals of Cancer Research and Therapy Vol. 29 No. 1, 2021

Ann. Cancer Res. Ther. Vol. 29, No. 1, pp. 30-33, 2021

Introduction

Thyroglossal cysts (TGC) and fistulas (TGF) are

formed as a result of the violation of the thyroid duct

lining (TDL), a path of ontogenetic migration of the

thyroid gland from the place of its foundation. From the

root of the tongue to the site of its usual location on the

front surface of the neck. TGC forms from days 16-24

of embryonic development at the bottom of the primitive

pharynx in the zone that developed from days 12–18 of

embryogenesis of the pharyngeal membrane separating

the mouth fossa and the primary intestinal cavity. At this

site, thickening of the entoderm occurs, and by day 28,

it begins to sink to the subject mesenchyme and forms

a thyroid diverticulum (diverticulum thyroideum). As

the bookmark of the thyroid sinks into the tongue tissue

and moves along the primary intestine, the diverticulum

deepens and transforms into TDL. In week 5 of embryo-

genesis, the developing hyoid bone splits from the TGP,

creating two unequal parts: the shorter tongue (duсtus

lingual) and the longer thyroid (ductus thyroids). In 5%–

7% of cases, TDL is associated with the horn of the hy-

oid bone, while it is associated with the div of the hyoid

bone in the remaining cases. Thus, the hyoid bone is the

most important reference point among the topographic

characteristics of the TGC

1-6)

.

By days 40–50 of embryogenesis, the TGC reaches its

usual position at the front surface of the neck. By week 8

of embryonic development, the TGP is obliterated, trans-

forming into fibrous epithelium that is gradually reduced

with age. On evaluating HR data, Harnsberger et al.

detected residual elements of the reduced TGP in more

than 7% of autopsies

4)

. Bogdanov et al. revealed induced

TGF residues in 25% of patients with TGC

5)

.

Anatomical evidence of the existence and ontoge-

netic migration of TGC is the blind tongue hole (natural

boundary between the div and root of the tongue and

site of the original location of the bookmark of the TGC

and sometimes found a pyramidal fraction of the TGH,

ULTRASOUND IMAGING OF THYROGLOSSAL CYSTS OF THE NECK

TO THE HYOID BONE

Lalita Yunusova

1)

, Toru Aoyama

2)

, Gayrat Ikramov

1)

, Bakhodir Halmanov

1)

, Junichi Sakamoto

3)

,

Hurriyat Kurbanbaeva

1)

1)

Tashkent State Dental Institute, Republic of Uzbekistan

2)

Department of Surgery, Yokohama City University, Japan

3)

Tokai Central Hospital, Japan

Abstract

Background: The present study attempted to clarify the typical anatomical variants of Thyroglossal cysts (TGC).

Patients and methods: Clinically and epidemiologically 67 previously non-experienced patients with TGC 1.5 to 73.0 years

old were examined.

Results: Based on clinical and ultrasound examinations of 121 patients with 67 thyroglossal cysts, the most typical cyst of

anatomical variations was specified. It was noted that, concerning the hyoid bone, thyroglossal cysts may be suprahyoid

(located at the root of the tongue), parahyoid (broadly adjoining the hyoid), prelingual (located in the front of the hyoid in

the hypo lingual region), postlingual (located behind the hyoid bone in the prenatal and peri-laryngeal spaces), or sublingual

(located the book from the hyoid bone). An ultrasound examination facilitated the identification of thyroglossal cysts with-

out clinical manifestations (23 sublingual cysts among 37 [62.2%] were incidentally revealed by the ultrasound examina-

tion), which is important when selecting the most appropriate surgical treatment.

Conclusion: Ultrasound studies facilitate the identification of TGCs located at the root of the tongue without any clinical

manifestations, which is important when determining the degree of surgical treatment to perform.

Keywords: thyroglossal cysts, ultrasound, topographic, anatomical variants

(Received January 14, 2021; Accepted February 1, 2021)

Corresponding author

: Toru Aoyama, Department of Surgery, Yokohama City

University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan. TEL: 81-45-

787-2800, E-mail: t-aoyama@lilac.plala.or.jp


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departing upwards from the isthmus of the TGC. In in-

ternational medical practice, cysts and fistulae arising

from the induced remnants of the TGP are considered

thyroglossal, while in domestic practice the term “me-

dian cysts and fistulae of the neck” is used more often. In

our opinion, these terms are not interchangeable, as the

very definition of TGC reflects not only the etiology but

also the probability of pathological changes throughout

the thyroid duct, from the root of the tongue to the usual

site of the thyroid, anddoes not correlate with the term

“middle cysts and fistulae of the neck”. At the same time,

the understanding that in the presence of a “median cyst

of the neck” is very likely the existence of changes in

the root of the tongue (in the form of a cyst or a fistula),

is otherwise organized the diagnostic process and, most

importantly, determines the treatment tactics.

In the existing topographic and anatomical classifica-

tions of TGC, the location of the cyst relative to the hyoid

bone is emphasized. Authors have classified cysts located

above the hyoid bone as being located in front of the hy-

oid bone, in the hypoplastic region of the front surface of

the neck

1)

. This definition is easy for operating surgeons

to comprehend but is not quite accurate with regard to

the topographic anatomy. It should be noted that current-

ly available classifications do not reflect the full range of

anatomical variants of TGC, which may result in misun-

derstandings between diagnosticians and surgeons.

The present study attempted to clarify the typical ana-

tomical variants of TGC.

Materials and Method

Clinically and epidemiologically 67 previously non-

experienced patients with TGC 1.5 to 73.0 years old were

examined. Echography was performed using ultrasound

scanners (an SLE-501; Lithuania; and an Affiniti-70;

Philips, Holland) with linear sensors with frequencies of

7.5-12 MHz.

If necessary, the differential diagnosis of cystic and

solid formations (mainly lymph nodes) was performed by

visualizing the blood flow (e.g. via color Doppler map-

ping or energy Doppler).

Results

The distribution of patients by age is presented in

Table 1. As can be seen, the peak of detection of TGC

not complicated by the presence of external cyst falls on

the age of 3 to 12 years old (50.8%). In general, potential

patients in children’s specialized departments (under 17

years old) account for 67.2% of patients. A total of 90

cysts were detected among the 67 patients: 14 patients

had 2 cysts each, 3 had 3 cysts each, and 1 had 4 cysts.

Therefore, 18 (26.9%) patients with TGC had multiple

cysts. In all cases, additional cysts (23 cysts in 18 pa-

tients) were located at the root of the tongue (Fig. 1). The

following variants of TGC to the hyoid bone were re-

vealed: suprahyoid cysts (located at the tongue root) (Figs.

2–4), parahyoid (widely adjoining to hyoid bone) (Fig.

5), sublingual (located in front of the hyoid bone in the

sublingual region) (Fig. 6), located behind the hyoid bone

in the prenatal and peri-laryngeal space (Fig. 7), and lo-

cated behind the hyoid bone (Figs. 8, 9). All prelingual

and sublingual cysts were associated with the hyoid bone

either by a fibrous sore throat or by their spurs.

Table 1 Patients background

Total number of patients

Age ranges

67

up to 3 years

3–7 years

8–13 years

14–17 years

between 18

and 25 years 26–45 years 46–60 years over 60 years

Absolute

6

15

19

5

9

4

6

3

Relative, %

8.9

22.4

28.4

7.5

13.4

6.0

8.9

4.5

Fig. 1 THC. multiple cysts in the root of

the language (arrow)


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Annals of Cancer Research and Therapy Vol. 29 No. 1, 2021

Fig. 3 THC. variant with rear

position of cyst in the
root of tongue. The cyst
is located behind the
line connecting the hyoid
bone and the blind hole
in the tongue, and has a
sauce with oropharynx
through the mucous root
of the tongue (arrows).

Fig. 4 THC. variant with a cyst

in the front position at
the root of the tongue.
The cyst is located at the
front of the line connect-
ing the hyoid bone and
the blind tongue open-
ing, spreading over the
mouth diaphragm from
the hyoid bone in the di-
rection of the chin austle
(arrows).

Fig. 2 THC. variant with central

location of cyst in the
root of language. The
cyst is located in the line
connec ting the hyoid
bone and the blind hole
of the tongue (arrows).

Fig. 9 De e p lo c ation of the

cyst. The cyst reaches
the cartilage or mucous
membrane of the larynx
(arrows).

Fig. 8 THC. The upper position

of the cyst between the
muscles of the sublin-
gual group (arrows).

Fig. 7 THC. The cyst is located

behind the hyoid bone
in the prenatal glandular
space (arrows).

Fig. 5 THC. The cyst is widely

adjacent to the hyoid
bone (arrows).

Fig. 6 The cyst is located at the

front of the hyoid bone in
the hypodlingual region
(arrows).


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Discussion

According to clinical examination data, the most

frequently identified types were sublingual (40.3%) and

circumlingual (25.4%) cysts, while the most frequently

found type was supra-lingual (root) cysts (20.9%). An

ultrasound investigation enabled the identification of

cysts at the root of the tongue without clinical manifes-

tations, which changed the idea about the frequency of

TGC of different localization. The most common TGC

variant was supernodalinguous cysts (41.1% of observa-

tions). Twenty-three of 37 sublingual cysts (62.2%) were

randomly detected on ultrasound and had no clinical

manifestations. Of the 37 sublingual TGCs, 17 (45.9%)

had a central position at the root of the tongue (along the

line connecting the hyoid bone and the blind hole of the

tongue, the conditional course of the tongue portion of

the thyroid duct), not adjoining the mucous membrane of

the tongue root; 14 (37.9%) were located behind this line,

widely adjoining the mucous membrane of the tongue

root or with a source in the oropharynx through the mu-

cous membrane of the tongue root; and 6 (16.2%) were in

front of this line, spreading over the jaw-lingual muscles

(mouth diaphragm) from the hyoid bone in the direction

of the chin. Of the 27 TGCs with hyoid localization, 19

(70.3%) were superficially located (between the breast

hyoid and shield hyoid muscles or in front of them), and

8 (29.7%) were deeply located, reaching the cartilage or

laryngeal mucosa.

Thus, the existing TGC classifications can be refined

with the detailed elaboration of the anatomical cyst lay-

out topography while still meeting the needs of surgeons.

To the hyoid bone, TGC can be defined as suprahyoid

(located at the root of the tongue), sublingual (located in

the root of the tongue), above sublingual (located at the

front of the hyoid bone - above the hyoid region), behind

the hyoid (located behind the hyoid bone at the epiglot-

tis), and behind sublingual (located behind the hyoid

bone in the epiglottis and collateral regions). Sublingual

TGCs may be centrally located at the root of the tongue,

along a line connecting the hyoid bone and the blind hole

of the tongue. A third type of tongue root cysts according

to Bezrukov

1)

; rear position relative to this line, broadly

adjoining the mucous membrane of the root of the tongue

or originating in the oropharynx through the mucous

root of the tongue (second type of cysts of the root of the

tongue according to Bezrukov

1)

) and the front position

relative to this line, spreading over the mouth diaphragm

from the hyoid bone in the board of the chin muscle

(first type of cysts of the root of the tongue according to

Bezrukov)

1)

.

Ultrasound studies facilitate the identification of

TGCs located at the root of the tongue without any clini-

cal manifestations, which is important when determining

the degree of surgical treatment to perform. Sublingual

TGCs may be located superficially (between the muscles

under the sublingual group) and deeply (near the throat,

reaching the cartilage or laryngeal mucosa). Of note, the

proposed classification of TGC describes only the most

frequently occurring (and therefore typical) variants and

does not reflect the diversity of manifestations of this

malformation. However, a thorough understanding of

the anatomical variants of TGC will help improve the

reliability of the diagnosis of this type of pathology, and

detailing the peculiarities of TGC location is important

for planning the scope of surgery.

Acknowledgments:

This study is supported, in part, by the nonprofit organization

Epidemiological and Clinical Research Information Network

(ECRIN).

References

1) Moshe Yehuda, Melissa E. Schechter, Nora Abu Ghanem,

Gilad Golan, Gilad Horowitz. European Archives of Oto-

Rhinolaryngology. 2017;16:15–19.

2) Wei S., Livolsi V.A., Baloch Z.W. Pathology of thyroglossal duct:

an institutional experience. Endocr. Pathol. 2015;26:75–79.

3) Hilary Pitner. Diagnostic Accuracy of Midline pediatric neck

masses. American Academy of Otolaryngology–Head and Neck

Surgery Foundation, 2019;46:55–69.

4) Erikci V., Hosgr M. Management of congenital neck lesions in chil-

dren. J. Plast. Reconstr. Aesthet. Surg. 2014;67:e217–22.

5) Hill S., Maddalozzo J. Congenital lesions of epithelial origin.

Otolaryngol Clin. N. Am. 2015;48:209–223.

6) Lim-Dunham J.E., Toslak E., Alsabban K., Aziz A., Okur G.,

Longo K.C. Ultrasound risk stratification for malignancy using the

2015 American Thyroid Association management guidelines for

children with thyroid nodules and differentiated thyroid cancer.

Pediatr Radiol. 2017;47(4):429–436.

Библиографические ссылки

Moshe Yehuda, Melissa E. Schechter, Nora Abu Ghanem, Gilad Golan, Gilad Horowitz. European Archives of Oto-Rhinolaryngology. 2017;16:15-19.

Wei S., Livolsi V.A., Baloch Z.W. Pathology of thyroglossal duct: an institutional experience. Endocr. Pathol. 2015;26:75-79.

Hilary Pitner. Diagnostic Accuracy of Midline pediatric neck masses. American Academy of Otolaryngology-Head and Neck Surgery Foundation, 2019;46:55-69.

Erikci V., Hosgr M. Management of congenital neck lesions in children. J. Plast. Reconstr. Aesthet. Surg. 2014;67:e217-22.

Hill S., Maddalozzo J. Congenital lesions of epithelial origin. Otolaryngol Clin. N. Am. 2015;48:209-223.

Lim-Dunham J.E., Toslak E., Alsabban K., Aziz A., Okur G., Longo K.C. Ultrasound risk stratification for malignancy using the 2015 American Thyroid Association management guidelines for children with thyroid nodules and differentiated thyroid cancer. Pediatr Radiol. 2017;47(4):429-436.

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