A rare case of a lingual mass in a neonate

Abstract

A large lingual cyst was noted on the 22-week antenatal ultrasound, which grew in proportion to the foetus on serial imaging. An elective c-section was performed in view of possible airway obstruction, and the neonate initially required oxygen to maintain saturations. Aged 1 month, the baby developed significant breastfeeding difficulties secondary to rapid cyst and secondary tongue enlargement, completely filling the oral cavity. Fifteen millilitres of fluid were aspirated in clinic, resulting in reduction of tongue size and immediate improvement in feeding. The patient subsequently underwent surgical excision of the cyst, which filled most of the anterior two-thirds of the tongue up to the foramen caecum. Histology supported the diagnosis of lingual thyroglossal duct cyst. A rare variant of thyroglossal duct cysts, these cysts can be potentially difficult to manage. More commonly located in the tongue base, we present an even rarer variant, that of an anterior tongue cyst.

Figure 1:

(a) and (b) Antenatal ultrasound at 28 weeks and MRI scan at 31 weeks demonstrating large fluid-filled oral cyst.

Figure 2:

Pre-operative photograph of superior aspect of tongue demonstrating significant tongue swelling, resulting in the tongue protruding past the lips.

Figure 3:

Pre-operative photograph of inferior aspect of tongue.

Figure 4:

Intraoperative photograph demonstrating surgical excision of the thryoglossal duct cyst.