Thyroglossal Duct Cyst — ORE Part 1 MCQ

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EasyOral SurgeryThyroglossal Duct CystORE Part 1

A 45-year-old patient presents with a swelling in the midline of the neck that moves upward on swallowing and on tongue protrusion. What is the most likely diagnosis?

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Correct answer: C — Thyroglossal duct cyst

Explanation lettering: B = shown as A · E = shown as B · A = shown as C · C = shown as D · D = shown as E

The correct answer is A. Thyroglossal duct cyst. The pathognomonic clinical feature is the dual movement: the swelling elevates with both swallowing (deglutition) and tongue protrusion. This occurs because the thyroglossal duct is an embryologic remnant extending from the foramen caecum at the base of the tongue downward to the thyroid gland, passing through or adjacent to the hyoid bone. Both swallowing and tongue protrusion tense structures in this tract, causing the characteristic upward displacement. The midline location further supports this diagnosis. Dermoid cysts (B) and branchial cleft cysts (C) are lateral neck lesions that do not move with tongue protrusion or swallowing. Cervical lymphadenopathy (D) lacks the specific dual movement and is often tender. Thyroid swelling (E) moves with swallowing alone, not tongue protrusion, and does not present as a discrete cystic mass in the midline tract.

Reference: Gandhi RA, Bhowate R, Degweker S, Bhake A. Infected Thyroglossal Duct Cyst Involving Submandibular Region: A Case Report. PubMed Central, 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335588/. Also: Thyroglossal Duct Cyst, a Case Report and Literature Review. PubMed Central, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8883879/