INTRODUCTION: Thyroglossal duct cysts are one of the most common midline lesions in the paediatric age group. They are epithelial remnants of the thyroglossal tract and present at the level of thyrohyoid membrane. Both sexes are equally affected. CASE HISTORY: A 25 yr old male came with complaints of neck swelling and fever for 1 week. He also gave history of neck swelling for past 1 yr which was evaluated elsewhere. He was suggested to do a CECT neck and FNAC of the swelling elsewhere which suggested thyroglossal cyst. He presented in our hospital with fever with chills, painful and tender neck swelling and restricted neck movement for 3 days following FNAC. CECT neck was repeated and suggested an infected thyroglossal cyst with abscess formation. He was started on broad spectrum antibiotics empirically. Patient underwent Incision and drainage of the abscess. About 50 cc of pus was drained and sent for culture and sensitivity. Pain and tenderness reduced, but induration was present. Antibiotics were changed based on the culture and sensitivity report and was taken up for surgery after 2 weeks. Fig. 1. Patient presents with infected thyroglossal cyst Fig 2. CECT Neck showing areas of necrosis and abscess formation Fig.3. Purulent discharge from abscess after incision and drainage of abscess was done. Methylene Blue was injected through a small granulation tissue in the Scar. Skin crease incision was made along the scar and all stained areas and tract was incised in toto along with a portion of the hyoid bone. Fig. 4. : Intraoperative thyroglosasal stula tract was identied by using methylene blue dye injection and tract excised in toto. As there was a lot of brosis of the neck muscles and loss of fascial planes due to inammation. The surgery was challenging. Intraoperative blood loss was slightly on the higher side. The postoperative period was uneventful and patient made a slightly delayed but complete recovery. Fig. 5. Postoperative picture after 45 days postoperative period INFECTED THYROGLOSSAL CYST Original Research Paper Dr. M. K. Rajasekar Professor Department Of Ent , Sree Balaji Medical College And Hospital X 153GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS ENT Thyroglossal duct cysts are one of the most common midline lesions in the paediatric age group affecting approximately 7% of the population. Infection and abscess formation are common complications. Infected neck mass is a common presentation of thyroglossal duct cysts in adults. Here we present a case of a 25 year old male with neck swelling and fever for 1 week. ABSTRACT KEYWORDS : Dr. Sridhara Narayanan* Professor Department Of Ent , Sree Balaji Medical College And Hospital *Corresponding Author Dr. S. Thrupthi Junior Resident Department Of Ent , Sree Balaji Medical College And Hospital VOLUME-8, ISSUE-9, SEPTEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra 154 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Fig.6. Histopathology report DISCUSSION: The thyroid gland originates at the foramen cecum of the tongue, at the apex of the V-shaped sulcus formed by the circumvallate papillae. During the fourth week of gestation, a ventral diverticulum of the foramen cecum is formed from the rst and second pharyngeal pouches. This diverticulum, with its narrow neck connected to the tongue, descends in the midline of the neck as the thyroglossal tract to the position of the normal thyroid in the base of the neck, where the thyroid lobes separate, by the seventh week. The path of descent is usually anterior to the hyoid bone, but may be posterior to or through the bone and ends on the anterior surface of the rst few tracheal rings. The tract usually atrophies and disappears by the tenth week of gestation, but remnants of the tract and thyroid tissue associated with it may persist at any point between the tongue and the thyroid. A thyroglossal duct cyst arises as a cystic expansion of a remnant of the thyroglossal duct tract. The stimulus for the expansion is not known; one theory is that lymphoid tissue associated with the tract hypertrophies at the time of a regional infection, therefore occluding the tract with resultant cyst formation. The cyst may occur anywhere along the thyroglossal duct tract from the foramen cecum at the base of the tongue to the level of the suprasternal notch. In most cases, the cyst is at or just below the hyoid bone adjacent to the thyrohyoid membrane. Cysts below the thyrohyoid membrane are rare. CONCLUSION: Our case report indicates that a strict aseptic precaution should be followed during invasive procedures like FNAC as FNAC is the rst line of investigation for most Head and Neck swellings. The presence of infection delays the procedure and wound healing with an increase in scarring. REFERENCES: 1. Mondin V, Ferlito A, Muzzi E, Silver CE, Fagan JJ, Devaney KO, Rinaldo A. 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Chirurgia (Bucur). 2008 Nov-Dec; 103(6):699-703 VOLUME-8, ISSUE-9, SEPTEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra