From the Research
The Sistrunk procedure is the recommended treatment for thyroglossal duct cysts, involving removal of the cyst, the central portion of the hyoid bone, and the tract leading to the base of the tongue, as it significantly reduces the recurrence rate to 3-5% 1.
Course of Thyroglossal Cyst
The course of a thyroglossal cyst begins during embryonic development when the thyroid gland descends from the base of the tongue to its final position in the neck, leaving behind a tract that normally disappears. When this tract persists and fills with fluid, a thyroglossal cyst forms, usually appearing as a painless midline neck mass that moves upward with swallowing or tongue protrusion.
Presentation and Diagnosis
These cysts commonly present in childhood or young adulthood and may become infected, causing pain, redness, and swelling. Diagnosis typically involves:
- Physical examination
- Ultrasound
- CT scan
- MRI
Treatment
While antibiotics like amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days) may be prescribed for infected cysts, they only provide temporary relief. Surgery remains the definitive treatment to prevent recurrence and the small risk of malignant transformation 2.
Surgical Procedure
The Sistrunk procedure is the most effective method for permanently excising a thyroglossal cyst, with a recurrence rate of 6% across all specialties 2. This procedure involves:
- Removal of the cyst
- Excision of the central portion of the hyoid bone
- Dissection of the tract leading to the base of the tongue
Postoperative Care
Patients should expect a small neck scar and a recovery period of 1-2 weeks following surgery. The Sistrunk procedure has been shown to be a safe and effective procedure, with no mortality or significant morbidity reported in some studies 3.