Stridor in an Elderly Woman: An Unusual Presentation of a Giant Thyroglossal Cyst

Thyroglossal cysts are one of the most common midline neck masses. They usually present as midline painless cystic neck mass in the first three decades of life. These anomalies are very rare in elderly patients and may pose difficult diagnostic and therapeutic challenges. Here, we report a case of giant thyroglossal cyst in a 72-year-female patient who presented with stridor, hoarseness of voice, and vocal cord paresis with gross distortion of normal airway anatomy secondary to pressure effect of the mass. The gross distortion and displacement of airway along with respiratory distress in this patient posed a difficult situation in securing the airway. The airway was secured by a unique way of orotracheal intubation with the help of a ventilating airway exchange catheter. The cyst was excised in toto under general anaesthesia. The stridor completely resolved after surgery and tracheostomy was avoided. 1. Introduction Thyroglossal cysts are one of the most common nonneoplastic neck masses in the paediatric population [1]. Thyroglossal cysts are formed due to aberrations in the normal development and descent of the median thyroid anlage. The thyroglossal duct begins to degenerate between the fifth and sixth fetal weeks [2]. Failure of involution of this tract with secretory activity of the lining epithelial cells secondary to infections leads to the formation of a thyroglossal cyst [2]. It is rare in the elderly patients with a reported incidence of approximately 0.6% in the 6th decade [3]. Thirteen cases have been reported in the literature after the age of 70 [3]. It usually presents as a painless midline neck mass intimately related to the hyoid bone and moves with protrusion of tongue and deglutition [1]. Patients with thyroglossal cyst may present with unusual symptoms like dysphagia, respiratory distress, and discharging fistulas. 2. Case Report A 72-year-old female patient presented to the emergency otolaryngology services with a huge anterior neck swelling, hoarseness of voice, and stridor. The swelling started as a painless lump in the upper part of neck which gradually increased in size over 5 years. The patient developed progressive difficulty in breathing and hoarseness of voice of one-month duration and noisy breathing (stridor) of 4-days-duration which brought her to the emergency department. There was no history of recent rapid increase in size of the swelling. The patient did not give history suggestive of any neurological illness, prior surgery, or trauma. On examination, the patient had severe stridor and hoarseness of voice which