Incidental Finding of Thyroglossal Duct Cyst in A Neonate During Endotracheal Intubation: A Case Report

Incidental Finding of Thyroglossal Duct Cyst in A Neonate During Endotracheal Intubation: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Incidental Finding of Thyroglossal Duct Cyst in A Neonate During Endotracheal Intubation: A Case Report Emanuele Trovalusci, Carlo Pizzolon, Silvia Tesser, Stefano Doratiotto, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3577797/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Apr, 2024 Read the published version in BMC Pediatrics → Version 1 posted 12 You are reading this latest preprint version Abstract Background Thyroglossal Duct Cyst (TDC) is a common lesion of the midline neck, originating from an incomplete involution of the thyroglossal duct. It is typically observed in pre-scholar patients and surgery is the treatment of choice to prevent infections. Here reported a case of incidental diagnosis in a newborn patient. Case presentation: a 3-week-old male baby was admitted to our hospital for weight loss and projectile vomits after breastfeeding. After a diagnosis of hypertrophic pyloric stenosis, the baby underwent pyloromyotomy. During the endotracheal tube placement, the anesthetist noticed the presence of a midline neck mass. The suspect of TDC was confirmed by an intraoperative ultrasound, so, despite the age of the patient, we proceeded with the excision of the lesion according to Sistrunk’s procedure to avoid future complications and anesthesia. Conclusions even if TDC is a common lesion of pediatric patients, no neonatal cases were ever described in the literature. An accurate physical examination and ultrasound are essential diagnostic tools to distinguish TDC from other middle neck lesions, particularly ectopic thyroidal tissue. Sistrunk’s procedure is the most effective surgical approach. When diagnosis is made in a newborn, we suggest postponing surgery, unless the baby requires general anesthesia for other surgical procedures, such as in our case. Thyroglossal Duct Cyst Sistrunk neonate midline neck mass Figures Figure 1 Figure 2 BACKGROUND Thyroglossal Duct Cyst (TDC) is the most common congenital lesion of the midline neck, affecting about 7% of the population. It is the result of an incomplete involution of the thyroglossal duct and, therefore, it can be found anywhere along the thyroid’s path of migration, from the foramen caecum to the sternal region. 1 TDC typically appears as an asymptomatic and circumscribed mass in the hyoid bone region filled with mucinous fluid, smooth and non-tender at the physical examination. Due to the contiguity with the tongue, the cyst can get infected by oral bacteria. It may evolve in an abscess and eventually to intermittent drainage through a fistula opening on the skin or in the throat. 2 TDC is usually diagnosed in preschool aged children, but it can be observed also in adult life, with a slight predominance for male patients. 3 Few cases of TDC in patients under 1 year of age are described in literature, but there are no cases reported in newborns. Our experience with an incidental finding of TDC in a 3-weeks-old patient is hereby described. CASE PRESENTATION This was a male baby born at 40 weeks of gestational age by caesarian section after a failed labor induction, weighing 3450 g. Fetal ultrasonography (US) had revealed left renal pelvis dilatation and borderline cerebral ventriculomegaly, but the baby was completely asymptomatic and discharged after birth. An US performed two weeks later confirmed the diagnosis of left hydronephrosis (IV grade), and dilatation of cerebral ventricles at the upper limit of normal ranges. At 21 days of life the patient was taken to the emergency room for recurrent projectile vomits after each breastfeed and weight loss. US examination confirmed the suspect of hypertrophic pyloric stenosis, and the baby was admitted in the surgical ward and taken to the operating room the next day. During orotracheal intubation, the anesthetist perceived the presence of solid swelling on the midline of the neck (Fig. 1). An US was then performed in the operating room and revealed a 2X2 cm cyst filled with anechoic fluid and delimited by thin walls; the thyroid was normal. Despite the patient’s age, the finding was compatible with a TDC, and the decision was to proceed with the cyst removal, after the pyloromyotomy, in order to prevent future episodes of inflection and to avoid another surgical session. Upon parents’ agreement, the cyst was removed according to Sistrunk's procedure (Fig. 2). Abundant presence of colloid material was observed during the cyst isolation, reinforcing the diagnostic suspect. The postoperative course was regular, and the baby was discharged on the 3rd postoperative day. Histopathologic examination of the cyst confirmed the diagnosis of TDC. A genetic consult was also requested considering the presence of multiple anomalies, but the family refused to perform further analysis. DISCUSSION AND CONCLUSIONS TDC should always be considered when evaluating a midline neck mass in a pediatric patient. Usual presentation consists of an asymptomatic mass which can sometimes be detected by parents. The cyst can also become evident after infections, appearing as a swollen and painful mass. If not treated, the infection can lead to spontaneous rupture and evolve into a draining sinus. This occurrence is more frequently associated with an upper respiratory infection. 2 In our case, the features and position of the lesion resembled an asymptomatic TDC, even if the age of the patient was atypical. Different studies discord on the mean age of presentation for TDC. In fact, TDC has a bimodal age distribution, with a peak in the first and the fifth decade of life, being frequently observed in pre-scholar age children. 4 Anecdotic cases of TDC diagnosed in infancy have been reported in literature, and the earliest presentation was observed in a 3-month-old baby. 5 Many differential diagnoses should be considered when a midline neck lesion is observed in a pediatric patient, in particular dermoid cysts, pilomatrixomas, branchial cleft remnants, lymphadenopathy, and ectopic thyroid. 2 A careful physical examination, asking the patient to extend the neck and swallow or protrude the tongue, could be helpful to distinguish TDC from other lesions of the neck. 6 Indeed, TDC usually moves accordingly to the tongue due to its attachment to the hyoid bone. This explains why the anesthetist was able to identify the cyst in our patient during the endotracheal tube placement. To confirm our suspect and exclude thyroid anomalies, an US was performed at the operating table. TDC usually appears as a thin-walled and well-circumscribed anechoic/hypoechoic cystic lesion, strictly associated to the hyoid bone. 7 Sometimes cysts could be filled with debris secreted by the epithelial cells, especially after episodes of infection or inflammation. 8 US imaging is also mandatory to exclude the presence of median ectopic thyroidal tissue in or near the thyroglossal duct. If this is the case, thyroid hormones should be dosed before surgery, because in 75% of cases the ectopic thyroid is the only functional tissue. 8 Second-level imaging exams, such as CT, MRI and thyroid scan, could be helpful in inconclusive cases. US revealed that the midline lesion of this patient had the typical characteristic of a TDC and the thyroid was normal. For this reason and for the concomitant general anesthesia, we decided to proceed with TDC excision after pyloromyotomy. Surgical management is the best therapy in case of TDC and it should be performed early to avoid infections or malignant degeneration (about 1% of cases 4 ). Sistrunk’s procedure represents the gold standard treatment because has the best outcome in terms of recurrence and complications. 9 It consists in the excision of the cyst together with the central portion of the hyoid bone and the thyroglossal duct tract connected to the base of the tongue. A wide core of surrounding tissues should be excised to remove all the remnants which could cause recurrence. 10,11 Our patient presented a series of pathological conditions, such as a high-grade hydronephrosis, borderline ventriculomegaly, hypertrophic pyloric stenosis, and TDC and a genetic consultation was requested. No specific syndromes were identified, and the CGH-array exam was suggested that was refused by the parents. In conclusion, even if extremely rare, the diagnosis of TDC should be considered when a midline neck lesion is observed in a newborn baby. In our opinion, the excision of the cyst should be performed to avoid infections and malignant degeneration, but we also recommend evaluating risks and benefits of the procedure in babies < 6 months, considering the impact of general anesthesia neurodevelopment of these patients. Declarations Ethics approval: all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Consent for publication : informed consent was obtained from the parents/legal guardians of all the participants included in the study. Availability of data and materials : The authors confirm that the data supporting the findings of this study are available within the article. Competing interests: Authors declare that they have no conflict of interest or financial ties to disclose. Funding: Authors received no financial support for the research, authorship, and/or publication of this article. Author Contributions : conceptualization, P.M., E.T. and D.G.; investigation, S.D.; writing—original draft preparation, C.P. and E.T.; writing—review and editing, E.T. and P.M.; supervision, P.M. All authors have read and agreed to the published version of the manuscript. Acknowledgements : not applicable References Amos J, Shermetaro C. Thyroglossal Duct Cyst. Pediatric Surgery: Diagnosis and Treatment . Published online July 18, 2021:237-240. doi:10.1007/978-3-319-04340-1_41 Quintanilla-Dieck L, Penn EB. Congenital Neck Masses. Clinics in Perinatology . 2018;45(4):769-785. doi:10.1016/j.clp.2018.07.012 Gaddikeri S, Vattoth S, Gaddikeri RS, et al. Congenital Cystic Neck Masses: Embryology and Imaging Appearances, With Clinicopathological Correlation. doi:10.1067/j.cpradiol.2013.12.001 Thompson LDR, Herrera HB, Lau SK. A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts. Head and Neck Pathology . 2016;10(4):465-474. doi:10.1007/s12105-016-0724-7 Atmaca S, Cecen A, Kavaz E. Thyroglossal Duct Cyst in a 3-Month-Old Infant: A Rare Case. Turk Otolarengoloji Arsivi/Turkish Archives of Otolaryngology . 2016;54(3):138-140. doi:10.5152/tao.2016.1636 Ünsal Ö. Clinical approach to pediatric neck masses. Retrospective analysis of 98 cases. Northern Clinics of Istanbul . Published online 2017. doi:10.14744/nci.2017.15013 Sidell DR, Shapiro NL. Diagnostic accuracy of ultrasonography for midline neck masses in children. Otolaryngology - Head and Neck Surgery . 2011;144(3):431-434. doi:10.1177/0194599810391743 Patel S, Bhatt AA. Thyroglossal duct pathology and mimics. Insights into Imaging . 2019;10(1). doi:10.1186/s13244-019-0694-x Ross J, Manteghi A, Rethy K, Ding J, Chennupati SK. Thyroglossal duct cyst surgery: A ten-year single institution experience. International Journal of Pediatric Otorhinolaryngology . 2017;101:132-136. doi:10.1016/j.ijporl.2017.07.033 Galluzzi F, Pignataro L, Gaini RM, Hartley B, Garavello W. Risk of recurrence in children operated for thyroglossal duct cysts: A systematic review. Journal of Pediatric Surgery . 2013;48(1):222-227. doi:10.1016/j.jpedsurg.2012.10.060 Marianowski R, Ait Amer JL, Morisseau-Durand MP, Manach Y, Rassi S. Risk Factors for Thyroglossal Duct Remnants after Sistrunk Procedure in a Pediatric Population . www.elsevier.com/locate/ijporl Additional Declarations No competing interests reported. Supplementary Files ABSTRACTgraphiccopia.docx Cite Share Download PDF Status: Published Journal Publication published 23 Apr, 2024 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 28 Mar, 2024 Reviews received at journal 24 Mar, 2024 Reviews received at journal 28 Feb, 2024 Reviewers agreed at journal 25 Feb, 2024 Reviewers agreed at journal 24 Feb, 2024 Reviews received at journal 20 Feb, 2024 Reviewers agreed at journal 19 Feb, 2024 Reviewers invited by journal 10 Feb, 2024 Editor assigned by journal 08 Feb, 2024 Editor invited by journal 25 Dec, 2023 Submission checks completed at journal 25 Dec, 2023 First submitted to journal 08 Nov, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3577797","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":263424875,"identity":"35d9db28-b03a-45b6-9eb8-375893706b13","order_by":0,"name":"Emanuele 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1","display":"","copyAsset":false,"role":"figure","size":1363334,"visible":true,"origin":"","legend":"\u003cp\u003ePre-operative picture of the thyroglossal duct cyst after endotracheal intubation.\u003c/p\u003e","description":"","filename":"Senzanome.001.png","url":"https://assets-eu.researchsquare.com/files/rs-3577797/v1/f42bf2f7edc13288919c2c0f.png"},{"id":49073074,"identity":"ee2fd24c-757e-44c0-a752-e0c66bda2cc4","added_by":"auto","created_at":"2024-01-02 17:24:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1853644,"visible":true,"origin":"","legend":"\u003cp\u003eThyroglossal Duct Cyst isolation during Sistrunk’s procedure\u003c/p\u003e","description":"","filename":"Senzanome.002copia.png","url":"https://assets-eu.researchsquare.com/files/rs-3577797/v1/d9f8584631dc600479a1f9e7.png"},{"id":55690732,"identity":"9541aaa4-15aa-4583-b0b2-a02f813d5843","added_by":"auto","created_at":"2024-05-01 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Report\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eThyroglossal Duct Cyst (TDC) is the most common congenital lesion of the midline neck, affecting about 7% of the population. It is the result of an incomplete involution of the thyroglossal duct and, therefore, it can be found anywhere along the thyroid\u0026rsquo;s path of migration, from the foramen caecum to the sternal region.\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTDC typically appears as an asymptomatic and circumscribed mass in the hyoid bone region filled with mucinous fluid, smooth and non-tender at the physical examination. Due to the contiguity with the tongue, the cyst can get infected by oral bacteria. It may evolve in an abscess and eventually to intermittent drainage through a fistula opening on the skin or in the throat.\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTDC is usually diagnosed in preschool aged children, but it can be observed also in adult life, with a slight predominance for male patients. \u003csup\u003e3\u003c/sup\u003e Few cases of TDC in patients under 1 year of age are described in literature, but there are no cases reported in newborns. Our experience with an incidental finding of TDC in a 3-weeks-old patient is hereby described.\u003c/p\u003e"},{"header":"CASE PRESENTATION","content":"\u003cp\u003eThis was a male baby born at 40 weeks of gestational age by caesarian section after a failed labor induction, weighing 3450 g. Fetal ultrasonography (US) had revealed left renal pelvis dilatation and borderline cerebral ventriculomegaly, but the baby was completely asymptomatic and discharged after birth. An US performed two weeks later confirmed the diagnosis of left hydronephrosis (IV grade), and dilatation of cerebral ventricles at the upper limit of normal ranges.\u003c/p\u003e \u003cp\u003eAt 21 days of life the patient was taken to the emergency room for recurrent projectile vomits after each breastfeed and weight loss. US examination confirmed the suspect of hypertrophic pyloric stenosis, and the baby was admitted in the surgical ward and taken to the operating room the next day.\u003c/p\u003e \u003cp\u003eDuring orotracheal intubation, the anesthetist perceived the presence of solid swelling on the midline of the neck (Fig.\u0026nbsp;1). An US was then performed in the operating room and revealed a 2X2 cm cyst filled with anechoic fluid and delimited by thin walls; the thyroid was normal. Despite the patient\u0026rsquo;s age, the finding was compatible with a TDC, and the decision was to proceed with the cyst removal, after the pyloromyotomy, in order to prevent future episodes of inflection and to avoid another surgical session. Upon parents\u0026rsquo; agreement, the cyst was removed according to Sistrunk's procedure (Fig.\u0026nbsp;2). Abundant presence of colloid material was observed during the cyst isolation, reinforcing the diagnostic suspect. The postoperative course was regular, and the baby was discharged on the 3rd postoperative day.\u003c/p\u003e \u003cp\u003eHistopathologic examination of the cyst confirmed the diagnosis of TDC. A genetic consult was also requested considering the presence of multiple anomalies, but the family refused to perform further analysis.\u003c/p\u003e"},{"header":"DISCUSSION AND CONCLUSIONS","content":"\u003cp\u003eTDC should always be considered when evaluating a midline neck mass in a pediatric patient. Usual presentation consists of an asymptomatic mass which can sometimes be detected by parents. The cyst can also become evident after infections, appearing as a swollen and painful mass. If not treated, the infection can lead to spontaneous rupture and evolve into a draining sinus. This occurrence is more frequently associated with an upper respiratory infection.\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn our case, the features and position of the lesion resembled an asymptomatic TDC, even if the age of the patient was atypical. Different studies discord on the mean age of presentation for TDC. In fact, TDC has a bimodal age distribution, with a peak in the first and the fifth decade of life, being frequently observed in pre-scholar age children.\u003csup\u003e4\u003c/sup\u003e Anecdotic cases of TDC diagnosed in infancy have been reported in literature, and the earliest presentation was observed in a 3-month-old baby.\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMany differential diagnoses should be considered when a midline neck lesion is observed in a pediatric patient, in particular dermoid cysts, pilomatrixomas, branchial cleft remnants, lymphadenopathy, and ectopic thyroid.\u003csup\u003e2\u003c/sup\u003e A careful physical examination, asking the patient to extend the neck and swallow or protrude the tongue, could be helpful to distinguish TDC from other lesions of the neck.\u003csup\u003e6\u003c/sup\u003e Indeed, TDC usually moves accordingly to the tongue due to its attachment to the hyoid bone. This explains why the anesthetist was able to identify the cyst in our patient during the endotracheal tube placement.\u003c/p\u003e \u003cp\u003eTo confirm our suspect and exclude thyroid anomalies, an US was performed at the operating table. TDC usually appears as a thin-walled and well-circumscribed anechoic/hypoechoic cystic lesion, strictly associated to the hyoid bone.\u003csup\u003e7\u003c/sup\u003e Sometimes cysts could be filled with debris secreted by the epithelial cells, especially after episodes of infection or inflammation.\u003csup\u003e8\u003c/sup\u003e US imaging is also mandatory to exclude the presence of median ectopic thyroidal tissue in or near the thyroglossal duct. If this is the case, thyroid hormones should be dosed before surgery, because in 75% of cases the ectopic thyroid is the only functional tissue.\u003csup\u003e8\u003c/sup\u003e Second-level imaging exams, such as CT, MRI and thyroid scan, could be helpful in inconclusive cases.\u003c/p\u003e \u003cp\u003eUS revealed that the midline lesion of this patient had the typical characteristic of a TDC and the thyroid was normal. For this reason and for the concomitant general anesthesia, we decided to proceed with TDC excision after pyloromyotomy. Surgical management is the best therapy in case of TDC and it should be performed early to avoid infections or malignant degeneration (about 1% of cases\u003csup\u003e4\u003c/sup\u003e). Sistrunk\u0026rsquo;s procedure represents the gold standard treatment because has the best outcome in terms of recurrence and complications.\u003csup\u003e9\u003c/sup\u003e It consists in the excision of the cyst together with the central portion of the hyoid bone and the thyroglossal duct tract connected to the base of the tongue. A wide core of surrounding tissues should be excised to remove all the remnants which could cause recurrence.\u003csup\u003e10,11\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOur patient presented a series of pathological conditions, such as a high-grade hydronephrosis, borderline ventriculomegaly, hypertrophic pyloric stenosis, and TDC and a genetic consultation was requested. No specific syndromes were identified, and the CGH-array exam was suggested that was refused by the parents.\u003c/p\u003e \u003cp\u003eIn conclusion, even if extremely rare, the diagnosis of TDC should be considered when a midline neck lesion is observed in a newborn baby. In our opinion, the excision of the cyst should be performed to avoid infections and malignant degeneration, but we also recommend evaluating risks and benefits of the procedure in babies\u0026thinsp;\u0026lt;\u0026thinsp;6 months, considering the impact of general anesthesia neurodevelopment of these patients.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eEthics approval:\u003c/u\u003e all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent for publication\u003c/u\u003e:\u0026nbsp;informed consent was obtained from the parents/legal guardians of all the participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAvailability of data and materials\u003c/u\u003e: The authors confirm that the data supporting the findings of this study are available within the article.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCompeting interests:\u003c/u\u003eAuthors declare that they have no conflict of interest\u0026nbsp;or financial ties to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFunding:\u003c/u\u003e Authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAuthor Contributions\u003c/u\u003e: conceptualization, P.M., E.T. and D.G.; investigation, S.D.; writing—original draft preparation, C.P. and E.T.; writing—review and editing, E.T. and P.M.; supervision, P.M. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAcknowledgements\u003c/u\u003e: not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAmos J, Shermetaro C. Thyroglossal Duct Cyst. \u003cem\u003ePediatric Surgery: Diagnosis and Treatment\u003c/em\u003e. Published online July 18, 2021:237-240. doi:10.1007/978-3-319-04340-1_41\u003c/li\u003e\n\u003cli\u003eQuintanilla-Dieck L, Penn EB. Congenital Neck Masses. \u003cem\u003eClinics in Perinatology\u003c/em\u003e. 2018;45(4):769-785. doi:10.1016/j.clp.2018.07.012\u003c/li\u003e\n\u003cli\u003eGaddikeri S, Vattoth S, Gaddikeri RS, et al. Congenital Cystic Neck Masses: Embryology and Imaging Appearances, With Clinicopathological Correlation. doi:10.1067/j.cpradiol.2013.12.001\u003c/li\u003e\n\u003cli\u003eThompson LDR, Herrera HB, Lau SK. A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts. \u003cem\u003eHead and Neck Pathology\u003c/em\u003e. 2016;10(4):465-474. doi:10.1007/s12105-016-0724-7\u003c/li\u003e\n\u003cli\u003eAtmaca S, Cecen A, Kavaz E. Thyroglossal Duct Cyst in a 3-Month-Old Infant: A Rare Case. \u003cem\u003eTurk Otolarengoloji Arsivi/Turkish Archives of Otolaryngology\u003c/em\u003e. 2016;54(3):138-140. doi:10.5152/tao.2016.1636\u003c/li\u003e\n\u003cli\u003e\u0026Uuml;nsal \u0026Ouml;. Clinical approach to pediatric neck masses. Retrospective analysis of 98 cases. \u003cem\u003eNorthern Clinics of Istanbul\u003c/em\u003e. Published online 2017. doi:10.14744/nci.2017.15013\u003c/li\u003e\n\u003cli\u003eSidell DR, Shapiro NL. Diagnostic accuracy of ultrasonography for midline neck masses in children. \u003cem\u003eOtolaryngology - Head and Neck Surgery\u003c/em\u003e. 2011;144(3):431-434. doi:10.1177/0194599810391743\u003c/li\u003e\n\u003cli\u003ePatel S, Bhatt AA. Thyroglossal duct pathology and mimics. \u003cem\u003eInsights into Imaging\u003c/em\u003e. 2019;10(1). doi:10.1186/s13244-019-0694-x\u003c/li\u003e\n\u003cli\u003eRoss J, Manteghi A, Rethy K, Ding J, Chennupati SK. Thyroglossal duct cyst surgery: A ten-year single institution experience. \u003cem\u003eInternational Journal of Pediatric Otorhinolaryngology\u003c/em\u003e. 2017;101:132-136. doi:10.1016/j.ijporl.2017.07.033\u003c/li\u003e\n\u003cli\u003eGalluzzi F, Pignataro L, Gaini RM, Hartley B, Garavello W. Risk of recurrence in children operated for thyroglossal duct cysts: A systematic review. \u003cem\u003eJournal of Pediatric Surgery\u003c/em\u003e. 2013;48(1):222-227. doi:10.1016/j.jpedsurg.2012.10.060\u003c/li\u003e\n\u003cli\u003eMarianowski R, Ait Amer JL, Morisseau-Durand MP, Manach Y, Rassi S. \u003cem\u003eRisk Factors for Thyroglossal Duct Remnants after Sistrunk Procedure in a Pediatric Population\u003c/em\u003e. www.elsevier.com/locate/ijporl\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Thyroglossal Duct Cyst, Sistrunk, neonate, midline neck mass","lastPublishedDoi":"10.21203/rs.3.rs-3577797/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3577797/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThyroglossal Duct Cyst (TDC) is a common lesion of the midline neck, originating from an incomplete involution of the thyroglossal duct. It is typically observed in pre-scholar patients and surgery is the treatment of choice to prevent infections. Here reported a case of incidental diagnosis in a newborn patient.\u003c/p\u003e\u003ch2\u003eCase presentation:\u003c/h2\u003e \u003cp\u003ea 3-week-old male baby was admitted to our hospital for weight loss and projectile vomits after breastfeeding. After a diagnosis of hypertrophic pyloric stenosis, the baby underwent pyloromyotomy. During the endotracheal tube placement, the anesthetist noticed the presence of a midline neck mass. The suspect of TDC was confirmed by an intraoperative ultrasound, so, despite the age of the patient, we proceeded with the excision of the lesion according to Sistrunk\u0026rsquo;s procedure to avoid future complications and anesthesia.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eeven if TDC is a common lesion of pediatric patients, no neonatal cases were ever described in the literature. An accurate physical examination and ultrasound are essential diagnostic tools to distinguish TDC from other middle neck lesions, particularly ectopic thyroidal tissue. Sistrunk\u0026rsquo;s procedure is the most effective surgical approach. When diagnosis is made in a newborn, we suggest postponing surgery, unless the baby requires general anesthesia for other surgical procedures, such as in our case.\u003c/p\u003e","manuscriptTitle":"Incidental Finding of Thyroglossal Duct Cyst in A Neonate During Endotracheal Intubation: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-02 17:16:22","doi":"10.21203/rs.3.rs-3577797/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-03-28T06:02:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-03-24T17:30:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-02-28T09:34:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"e1362e60-d4b3-4a3c-ac7b-e5e9b5cf0bdc","date":"2024-02-26T04:09:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"eae26755-3a6a-4912-95b0-aa8a8c7f37d2","date":"2024-02-24T05:47:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-02-20T21:56:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"78b557e5-38e6-4d62-bfb5-1fb8dce88d1a","date":"2024-02-19T13:56:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-02-10T10:29:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-02-08T14:31:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-12-25T13:06:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-12-25T13:03:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2023-11-08T06:53:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a07493bb-d32d-4a97-8963-755b7c560039","owner":[],"postedDate":"January 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-05-01T22:49:53+00:00","versionOfRecord":{"articleIdentity":"rs-3577797","link":"https://doi.org/10.1186/s12887-024-04742-x","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2024-04-23 22:49:53","publishedOnDateReadable":"April 23rd, 2024"},"versionCreatedAt":"2024-01-02 17:16:22","video":"","vorDoi":"10.1186/s12887-024-04742-x","vorDoiUrl":"https://doi.org/10.1186/s12887-024-04742-x","workflowStages":[]},"version":"v1","identity":"rs-3577797","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3577797","identity":"rs-3577797","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}