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Abstract
A thyroglossal duct cyst (TGDC) is one of the most common causes of anterior midline neck mass. Successful management of a TGDC requires histopathology and an understanding of the embryogenesis of the thyroid. Traditional TGDC surgery uses a transcervical approach, which results in an external neck scar. In contrast to the surgical removal of a benign neck mass, TGDC surgery should include removal of the cyst, the hyoid bone, and the thyroid remnant track from the foramen cecum to the hyoid bone. Considering the embryological development of the TGDC, it was evident to us that an entirely transoral approach to the TGDC region was an option. Before its descent, the TGDC originates from the bottom of the tongue. The TGDC is located behind the strap muscles of the neck and the hyoid bone. Following this naturally predetermined access alongside the TGDC, we were able to develop a new surgical approach to the TGDC area and introduced the transoral TGDC excision.
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Fig. 1.
The presentation of transoral approach. After fre-notomy, we can find genio-glossus muscle and retrac-ted bilaterally. After that we can approach to the anterior neck area.
Fig. 2.
Transoral approach through a midline incision of the floor of the mouth. (A, B) CT scan confirmed the sub-mental mass between both digastric muscle and below mylohyoid muscle. (C) Verti-cal incision was made in the midline of the floor of the mouth through the frenulum. After dissection of the soft tissues in the floor of the mouth, the genioglossus muscles were separated in the midline, and retracted bilaterally. After re-traction of the genioglossus muscles, we exposed the my-lohyoid muscles. With the en-doscopic guidance, we identi-fied the mass like lesion after resection of the mylohyoid muscles. (D) After dissecting the soft tissue around the mass, we removed it.
Fig. 4.
Computed tomo-graphy scan confirmed the 2-cm mass found just in-ferior to the level of the hyoid bone.
Fig. 5.
Transoral approach through a frenotomy incision of the mouth. (A, B) Vertical incision was made in the midline of the floor of the mouth through the frenulum. (C) After dissection of the soft tissues in the floor of the mouth, the genioglossus muscles were separated in the midline and retracted bilaterally. (D) After retraction of the genioglossus muscles, we found some midline longitudinal tissue (arrow). (E, F) This tissue extended from the midline of the hyoid bone toward the tongue base. After dissection, we cut the tissue between the tongue base and the hyoid bone. (G) With endoscopic guidance, we identified the hyoid bone (arrow). We dissected the soft tissue around the hyoid bone. (H) We cut the hyoid bone by 1 mm Osteo Punch Rongeur. (I) After cutting the hyoid bone (arrow), while pulling the hyoid bone upward, by careful cyst dissection we could remove the cystic mass attached to the hyoid bone en bloc by a stalk. (J) After removing the thyroglossal duct cyst, we found the thyroid cartilage (arrow). (K) Surgical specimen, arrow indicates the midportion of the hyoid bone. (L) Surgical specimen, the soft tissue between the tongue base and the hyoid bone.
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