Thyroglossal duct cyst and fistula
Introduction
Brief introduction of thyroid gland cyst and sputum The thyroglossal cyst and hernia are congenital dysplasia caused by incomplete thyroid tongue degeneration. If the intraductal epithelial cells do not degenerate during development, a thyroid gland cyst can be formed in any part of the midline between the blind hole and the sternal neck incision. The cyst is formed by sputum rupture or surgical incision. Most occur in the age of 5, men are slightly more than women, about 40% of patients with infection, adults have also found. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: Tongue thyroid
Cause
Thyroid gland cyst and sputum cause
Cause:
At the third week of the embryo, in the middle part of the first and second pairs of pharyngeal recesses in the pharyngeal base of the original oral cavity, a diverticulum-like thyroid base is formed, which starts to move down the median line in the front of the throat to the neck. Department, the path constitutes a slender catheter called the thyroid tongue. The hyoid bone develops from the sides to the middle of the catheter or surrounds the front and rear. The lower end forms the thyroid gland. By the fifth week, the thyroid gland is degenerated. The parenchymal fibrous cord remains as a blind hole in the base of the tongue. If the epithelial cells in the duct do not degenerate during development, the thyroid gland cyst can be formed in any part of the midline between the blind hole and the sternal neck incision. .
Prevention
Thyroid gland cyst and sputum prevention
Prevention and prognosis:
(1) Make good use of the intraoperative blue and blue traces and try to cut small branches or fistulas. In the case of the methylene blue tracing, large cysts or fistulas are only required to be carefully manipulated to prevent the pollution of the blue field, which generally has a good effect. For small cysts or small fistulas, combined with preoperative B-ultrasound analysis, no injection of methylene blue. 5 After the separation of the iliac crest or small branch, the branch or the fistula is separated into the hyoid bone, the middle segment of the hyoid bone is removed about 1.5 cm. Electrocoagulate the end of the tongue and then suture it.
(2) The scope of the hyoid bone removal should be sufficient. From the embryonic development of the thyroglossal cyst, the cyst and the fistula of the fistula do not all pass through the center of the hyoid bone. It can be worn from different parts of the middle part of the hyoid bone or through the surrounding tissue without wearing the hyoid bone. The fistula can be multiple roots or a single root. Hosawa et al. found that at the level of the hyoid bone, the distance from the farthest branch of the thyroid gland is 0. 24 to 0.96 cm. Therefore, it is required to remove at least 1.0 cm of the hyoid bone and remove the attached tissue. Generally, the hyoid bone is removed about 1. 5 cm.
(3) For cases of repeated infection or recurrence, it is first necessary to control the infection, and the surgery will be performed after the inflammation has subsided for 2 months. Secondly, all scar tissue, fistula and cyst wall should be removed as much as possible during surgery. If it can not be removed, it can be burned by electrocoagulation.
Complication
Thyroid gland cyst and hernia complications Complications
About 40% of cases are complicated by infection.
Symptom
Thyroid gland cyst and sputum symptoms Common symptoms Tongue abscess pharyngeal foreign body sensation The tongue area has swelling and tenderness. There is a long time on the tongue... The thyroid cartilage can be touched...
In the middle of the neck is equivalent to the thyroid cartilage under the hyoid bone. A circular mass of 1 to 2 cm in diameter is visible. The surface is smooth and the edges are clear. The cystic shape is solid due to the tightness of the filling. It is relatively fixed and cannot be pushed up or down or left and right, but Slightly move up and down with swallowing or stretching of the tongue. Small cysts can reach a suture to the hyoid bone. When there is no infection, no adhesion to the skin, no tenderness, pain and tenderness, self-rupture or incision drainage After the formation of the thyroid gland, the transparent or turbid mucus is often discharged from the fistula. After a certain period of time, the fistula can temporarily seal the crusting, but soon the fluid is broken, which can occur repeatedly, and healed for a long time. In the depths, the cord-like tissue that can sneak up and sneak up leads to the tongue tube.
Examine
Thyroid gland cyst and hernia examination
Visual examination: There is a round mass under the plane of the anterior hyoid bone. The surface is smooth, the boundary is clear, the capsule is sexy, the skin is non-adhesive, and it moves up and down with swallowing. The cord can be touched along the direction of the hyoid bone, and the mouth can be swollen and retracted when the mouth is extended.
Diagnosis
Diagnosis and diagnosis of thyroid gland cyst and hernia
diagnosis
1, more common in children and young people, there is a round lumps under the plane of the anterior lingual bone, the surface is smooth, the boundary is clear, the sac is sexy, the skin is non-adhesive, moving up and down with swallowing, touching the cord along the direction of the hyoid bone, opening the tongue When you can feel swollen and retracted.
2, cyst secondary infection, local redness and tenderness, self-destruction or incision drainage, can form a sputum into the unhealed.
3, mucinous secretions, often containing columnar and squamous epithelial cells.
10 to 20% of the cyst is located above the hyoid bone, and should be differentiated from the axillary lymphadenitis and dermoid cysts that occur in this area. The cyst is located between the sternum and the thyroid gland, and should be associated with tracheal-derived cysts, dermoid cysts, and thyroid cysts. Softened tuberculous lymph nodes, ectopic salivary gland cysts, especially to pay attention to ectopic thyroid gland, literature reported that thyroid dysfunction occurs after miscut, because 70% of cases are absent like normal thyroid, therefore, if necessary, thyroid Scanning and functional examination, cysts slightly in the median line should be identified with sacral cysts.
