Best of five
- A. Simple cyst drainage
- B. Confirm functioning thyroid tissue and define anatomy
- C. Immediate excision without thyroid assessment
- D. Radical neck dissection
- E. Radioactive iodine ablation
FRCS (ORL-HNS) · SECTION 1 SBA
Congenital neck mass
A child has a painless midline neck mass that moves upward on tongue protrusion. Ultrasound shows a cystic lesion and no normal thyroid in its usual position. What must occur before excision?
B. Confirm functioning thyroid tissue and define anatomy
A thyroglossal-duct remnant can contain the patient's only functioning thyroid. Imaging and thyroid assessment prevent removal of ectopic sole thyroid tissue; definitive surgery is a Sistrunk procedure when appropriate.
Why every option is right or wrong
A. Simple cyst drainage: This has high recurrence and does not address the tract.
B. Confirm functioning thyroid tissue and define anatomy: A thyroglossal-duct remnant can contain the patient's only functioning thyroid. Imaging and thyroid assessment prevent removal of ectopic sole thyroid tissue; definitive surgery is a Sistrunk procedure when appropriate.
C. Immediate excision without thyroid assessment: This could render the child hypothyroid.
D. Radical neck dissection: There is no evidence of malignancy or nodal disease.
E. Radioactive iodine ablation: This is not treatment for a benign developmental cyst.
What if the scenario changed?
If a normal orthotopic thyroid were confirmed, Sistrunk excision could proceed after infection had settled.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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