Thyroid cyst, fistula removal

During the embryonic period, the thyroid primordium on the ventral ventral side of the pharynx moves down to the caudal side, forming a thyroglossal duct connected to the starting point. Beginning at the 6th week of the embryo, the tube gradually degenerates and disappears. If the deterioration disappears, it is possible to form a cyst, fistula or sinus along the site through which the tube passes. Because the cyst and fistula are located in the midline of the neck, it is also called congenital neckline cyst and fistula. According to clinical observations, cysts or fistulas are not necessarily in the midline, and quite a few tend to be slightly to one side. It can occur anywhere in the midline of the neck from the blind hole to the sternum, but 85% of the cyst is located in the periosteum of the thyroid. Cysts are more common than fistulas. The large group of cases in China reported a ratio of cysts to fistulas of 2:1, and 35% of cysts were associated with sinus. The fistula or sinus can be congenital or secondary to cyst infection. The inner mouth of the fistula is a blind hole in the tongue. When the thyroid gland begins to degenerate, the cartilage of the left and right cartilage begins to fuse. Therefore, the thyroid gland may be located on the ventral or dorsal side of the hyoid bone, and may also be enclosed in the hyoid bone. In the removal of the thyroid gland cyst or fistula, the middle part of the hyoid bone is often removed. Treatment of diseases: thyroid gland cysts and fistula Indication Whether it is a cyst or fistula, once diagnosed, except in the acute infection period, surgical resection should be done as soon as possible. Once infected, it will increase the difficulty of surgery. Children under the age of 4 can be postponed until the age of 4 years. Preoperative preparation In addition to the routine preoperative preparation, the developer can be injected into the X-ray film by the external fistula to show the whole process of the fistula or the fistula, or the dye can be dyed to stain the fistula, which is convenient for tracking and separation during surgery. Surgical procedure (1) Cross the central part of the cyst to make a transverse incision parallel to the hyoid bone, reaching the platysma. When the fistula is removed, a diamond incision can be made around the fistula and extended to the sides. (2) Retract the skin flaps up and down to reveal cysts. Due to the different size of the cyst, it can be exposed above the superficial fascia of the neck, or it can be buried deep under the fascia of the trachea. (3) Separating the tissue around the cyst or fistula, revealing the hyoid bone, separating the middle part of the hyoid bone from the sternum muscle and the lingual membrane, and cutting the middle lingual body together with the periosteum. (4) Pull the cyst or fistula together with the hyoid bone and continue to separate the fistula from the blind hole. At this point, the assistant puts his finger into the cavity and pushes the base of the tongue forward. When the separation is about 3 mm from the blind hole of the tongue, the fistula can be ligated and cut, or it can be divided into the root of the tongue together with the part of the base of the tongue and the fistula. If the pharyngeal cavity is cut through during the resection process, the intestine can be sutured in the intestine to close the pharyngeal cavity. (5) The incision is layered and sutured, and the dead space is left as far as possible. When the wound cavity is large, the drainage strip can be placed.