Thyroglossal duct cyst presenting as life-threatening airway obstruction in a neonate

Thyroglossal duct cysts are the most common congenital abnormality in the neck, accounting for 70-75% of midline neck masses in children [1]. Late in the 4th week of gestation, the thyroid anlage develops as a small, solid mass of endoderm proliferating at the foramen cecum. As the thyroid anlage descends caudally in the neck, it maintains an attachment to the site of origin at the level of the foramen cecum of the tongue via the thyroglossal duct [2]. The thyroglossal duct typically involutes and atrophies between 7 and 10 weeks of gestation by the time the thyroid gland reaches its final position inferior to the cricoid cartilage [2]. The source of TGDC is believed to be persistent remnants of the thyroglossal duct. Due to the communication of the duct to the mouth via the foramen cecum, thyroglossal cysts can become infected with oral flora. One-third of patients of all ages will present with a concurrent or prior infection, and one-quarter will present with a draining sinus from spontaneous or incisional drainage of an abscess [3]. The cysts occur almost equally in both sexes [4,5].