Update on Endoscopic Management of Lingual Thyroglossal Duct Cysts

Objectives/Hypothesis: Thyroglossal duct cysts (TGDC) are uncommon congenital midline neck masses arising from tubal remnants of embryologic thyroid descent. A rare variant of TGDC can present in the central tongue base and is named lingual TGDC (LTGDC). Left untreated, LTGDC may present with life-threatening airway obstruction. TGDC require surgery for cure; however, the surgical approach to LTGDC has not been discussed fully. This study was designed to examine the incidence, clinical features, and surgical management of LTGDC. Study Design: Retrospective chart review. Methods: Retrospective chart review of patients from a pediatric tertiary care institution diagnosed with lingual TGDC from 1997 to 2008. Results: One hundred eighty-nine patients underwent surgical excision of TGDC, of which 16 (8.5%; mean age, 3 years) presented with lingual TGDC alone. Most lingual TGDC were discovered incidentally, although seven patients (44%) presented with moderate to severe upper airway obstruction. Endoscopic transoral excision was performed in each case. This included suspension laryngoscopy with electrocautery, electrocautery, and cold dissection, or a combination of microdebridement and electrocautery. Most patients were intubated electively overnight for airway protection. All patients recovered without complication and have shown no evidence of recurrence (median follow-up, 3.7 years). Two LTGDC cases were revisions of prior surgeries (marsupialization and an open procedure) performed at outside hospitals. Conclusions: Although rare, LTGDC frequently present as a prominent tongue base mass with the potential of life-threatening airway obstruction. Herein we described the typical presentation, workup, and ideal surgical approach of these lesions. Complete surgical extirpation can be performed successfully with endoscopic techniques and minimal risk of complication or recurrence.