Thyroglossal duct cyst (fistula) resection

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. When the embryo develops to 6-7 weeks, the pocket protrusion should shrink and disappear, and only the residue at the beginning of the tongue root remains a blind hole. If the pocket is not closed, a cyst or fistula is formed between the hyoid bone and the thyroid cartilage. 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. The thyroid gland cyst or fistula is found before the age of 10, and can also be found when symptoms appear in adulthood. The age of onset in China is mostly 6 to 12 years old. The minimum age of onset is several days after birth, and the maximum is 74 years old. A few cases can be cancerous, 20% of which occur before the age of 20. Treatment of diseases: thyroglossal cyst cystic duct cyst and cleft palate Indication 1, the nail cyst (sacral canal) removal surgery is suitable for the tongue cyst, fistula without acute infection. 2, whether it is a cyst or fistula, once diagnosed, in addition to the acute infection period, should be surgically removed 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 Preoperatively, the fistula can be used as a lipiodol angiography to understand the direction of the fistula. Surgical procedure 1, position Take the supine position, the shoulders under the shoulders, the neck extension, the head back. 2, cutting Along the lower edge of the hyoid bone, the central part of the hyoid bone is the midpoint, and a horizontal incision of about 4-5 cm is made. After cutting the skin, subcutaneous tissue, and platysma, pull it open with a pull tab to expose the muscles around the hyoid bone. 3. Exposure of cysts The muscles around the hyoid bone are separated and retracted to the sides, exposing the cyst beneath it. Separate from the surrounding tissue along the wall of the capsule until the pedicle of the cyst. 4, treatment of the hyoid bone If the pedicle of the cyst passes over the hyoid bone or under the hyoid bone, the middle part of the hyoid bone can be cut with a hyoid bone scissors. If the pedicle of the cyst passes through the hyoid bone, the middle part of the hyoid bone should be cut off for a short period. 5, remove the cyst After separating the two ends of the hyoid bone and pulling it with a hook, peel it upward, cut it at the near blind hole, ligature the pedicle, and remove the cyst. 6, stitching The muscles around the hyoid bone were sutured in the midline, and the wound was sewed layer by layer, and a small rubber strip was drained, and the dressing was applied with a sterile dressing. 7, fistula removal In the operation of the tibial tube, before the incision, the methylene blue or the blue purple is injected into the fistula tube to make the fistula color, and then the fistula is removed according to the method of removing the cyst.

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