THYROGLOSSAL DUCT CYST EXCISION –  THE PROCEDURE AND THE RISKS

 

Thyroglossal duct  cyst excision is performed to remove an embryological remnant of thyroid tissue in the neck which presents as a swelling under the chin. If often becomes inflamed and painful. Cure of the cyst requires removal, not just of the cyst itself, but the entire embryological track extending from the base of the tongue down to the true thyroid gland. This includes the central part of the hyoid bone which lies at the base of the tongue. Thyroglossal duct  cyst excision is a straightforward procedure performed under general anaesthesia, with a supplemental local anaesthetic cervical plexus block to reduce post-operative pain and discomfort. An incision is required and this is best placed in a skin crease  high in the neck in order to provide an optimal cosmetic outcome. A hospital stay of either one night is standard.

 

Any operation carries with it the risk of a complication or unanticipated outcome. General risks  of any operation include the possibility of an anaesthetic reaction,  bleeding, infection, or thrombosis. There are also clearly a significant number of exceedingly uncommon potential complications  which cannot be detailed.  The specific  risks of total thyroidectomy include:

 

DAMAGE TO THE  SUPERIOR LARYNGEAL NERVES: The superior laryngeal nerves supply some of the muscles of the larynx which are responsible for the voice as well as for protecting the airway. They also supply the sensation to the inside of the larynx. These nerves run close to the operative site and lie above the thyroid gland. They may be stretched during removal of the cyst and hyoid bone and may be damaged, or may temporarily lose their function after surgery.  Loss of function affects the speaking and singing with a loss of projection or loss of the upper register, however there is usually no effect on the normal speaking voice.

 

PERSISTENT DISEASE: At surgery every attempt is made to remove all of the thyroglossal cyst and track, however sometimes small embryological remnants may be left behind and these can slowly grow to cause a recurrent cyst. This is more common if there has been significant infection, making removal of the hyoid bone more difficult. The risk of this happening is  around 2%.