8.16 Congenital Midline Neck Masses
Key Features
Thyroglossal duct cysts, dermoid cysts, and lipomas are common midline congenital masses.
Thyroid cancer can develop from a thyroglossal duct cyst, rarely.
Treatment requires complete surgical excision.
Thyroglossal duct cysts are midline masses that may appear anywhere between the base of the tongue and the thyroid gland. Dermoid cysts typically present in the submental area of the neck but can appear in other areas of the head and neck. Lipomas are derived from adipose tissue and present as soft painless masses that may occur anywhere in the body.
Epidemiology
Thyroglossal duct cysts are the most common congenital neck mass, present in 7% of the population. Lipomas are the most common soft tissue tumor. They may occur at any age but are common after age 40.
Clinical
Signs and Symptoms
Thyroglossal duct cysts are firm, mobile typically midline masses and can appear anywhere along the path of the thyroid′s descent. They can be off-midline. They will elevate upon protrusion of the tongue or swallowing and are usually asymptomatic. However, large cysts, or those in the base of the tongue, can compress the airway, causing dysphagia and respiratory difficulties. Cysts can become infected and may also enlarge after an upper respiratory infection.
Dermoid cysts are attached to and move with the skin. They are usually located in the submental area. They do not move upon swallowing or protrusion of the tongue. They are typically asymptomatic unless infected.
Lipoma presents as a soft, movable lump under the skin. They occur in the neck but also in multiple tissues and locations throughout the body.
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