A 56-year-old Caucasian woman was referred to the oral and maxillofacial surgery clinic with progressive dysphagia for 6 months.
The patient also complained of a sharp foreign body sensation at the time of implantation.
Personal history included psychomotor retardation with borderline intellectual quotient and functional limitation in the right lower limb.
He had short stature and hypothyroidism never assessed.
The intraoral examination vaguely revealed a vesicular, vascularized, hard and non-painful tumor on the lingual midline after the foramen caecum.
The visible tumor surface showed no ulcerations.
No cervical lymphadenopathy.
MRI showed a uniform tongue-based mass of approximately 5 x 4 cm compatible with lingual thyroid with severe airway obstruction.
The study was completed with isotopic scintigraphy with Tc99, which distinguishes marked tongue-based uptake without uptake in the usual hyoid prelaryngeal position.
She was referred to the endocrinologist to control her thyroid function and with the diagnosis of presumptive lingual thyroid surgery was decided given the progressive obstructive dysphagia.
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Under general anesthesia, an ostomy is initially performed which ensures an adequate airway because of the significant size and posterior location of the tumor on the lingual base.
A suprahyoid medial cervicotomy combined with de-riostization of the mandibular lingual table and posterior pull-through lingual table were performed, which extended the surgical control at the time of resection.
Given the posterior and deep tumor situation, it is necessary to perform an exangue middle glossotomy that allows complete tumor excision under direct control without associated lesion of vital adjacent structures.
Finally, the surgical approaches are closed in layers.
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The patient had an excellent evolution and was decannulated in the immediate postoperative period.
Pathology confirmed the diagnosis of lingual thyroid.
Control MRI showed absence of lingual thyroid tissue.
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It is followed by periodic reviews by ours and by the endocrinologist with control of basal hypothyroidism.
