Modified Essay Questions, MEQs in Surgery - Thyroglossal Cyst


# A teenage girl comes to you in surgery OPD with a 4 cm size swelling on the right side of neck just medial to the anterior border of sternocleidomastoid at the level of the upper border of the thyroid cartilage. She has no complaints except mild pain at the time of mastication. 1. List 3 differential diagnosis.

  • Thyroglossal cyst 
  • Branchial cyst 
  • Enlarged lymph node (at the level of thyroid cartilage, the thyroglossal cyst may be pushed slightly towards one side) 

2. Mention the specific question to be asked.

  • Duration of swelling 
  • Movement with deglutition 
  • Movement with protrusion of the tongue 

3. Mention the single most important investigation to be done in this patient. 
- Thyroid scan, as it may be the only functioning thyroid tissue in the body.

She comes to surgery OPD on next week with the report. After reading the report, the faculty member  in the OPD counsels her for operation as early as possible and also explains about the good prognosis. 
4. State the operation advised and also describe the process. 
- Sistrunk operation: Cyst along with the entire thyroglossal tract is excised. The Central portion of hyoid bone and lingual muscle are too removed. Removal facilitated by pressing posterior 1/3rd of the tongue. Do not perforate the thyrohyoid membrane.

5. List 2 important complications of this operation.
- Recurrence, thyroglossal fistula formation.

6. Mention the follow up with reason.
Return if swelling recurs (recurrence or papillary ca, which is a known complication).