A 56-year-old Caucasian woman was referred to the oral and maxillofacial surgery department with progressive dysphagia of 6 months' duration. She also reported an accentuated foreign body sensation on swallowing. His personal history includes psychomotor retardation with borderline IQ and functional limitation of the right lower limb. She was short in stature and hypothyroidism, which had never been assessed.
The intraoral examination revealed a vaguely purplish, vascularised, hard and non-painful tumour on palpation in the lingual midline behind the foramen caecum. The visible tumour surface is not ulcerated. No cervical lymph nodes were palpated. An MRI scan was requested showing a uniform mass at the base of the tongue measuring approximately 5 x 4 cm compatible with lingual thyroid with severe obstruction of the airway. The study was completed with an isotopic scintigraphy with Tc99 which showed accentuated uptake at the base of the tongue with no uptake in the usual pre-laryngeal hyoid position. The patient was referred to an endocrinologist to check his thyroid function and with the diagnosis of lingual thyroid, surgery was decided given the progressive obstructive dysphagia.

Under general anaesthesia, a tracheostomy was initially performed to adequately secure the airway given the large size and posterior location of the tumour at the base of the tongue. A suprahyoid mid cervicotomy is performed, combined with deperiostealisation of the mandibular lingual table and posterior lingual pull-through to increase surgical control at the time of resection. Given the deep posterior location of the tumour, an exsanguinating median glossotomy is required, which allows complete tumour excision under direct control without associated injury to vital adjacent structures. Finally, the approach routes are closed in planes.

The patient had an excellent evolution and was decannulated in the immediate postoperative period.
The pathological anatomy confirms the diagnosis of lingual thyroid. The follow-up MRI showed an absence of lingual thyroid tissue.

She was followed up by us and by the endocrinologist for regular check-ups to monitor her baseline hypothyroidism.