From the Research
Incision and drainage of a thyroglossal duct cyst with abscess formation may not significantly increase the risk of fistula formation, as suggested by the most recent and highest quality study available 1. The management of thyroglossal duct cysts with abscess formation is a complex issue, and the decision to perform incision and drainage should be made on a case-by-case basis. Some key points to consider include:
- Initial management should focus on controlling the infection with appropriate antibiotics, such as amoxicillin-clavulanate 875/125 mg twice daily or clindamycin 300-450 mg four times daily for 7-10 days, before proceeding to definitive surgical management 1.
- If abscess drainage is absolutely necessary due to severe symptoms or airway compromise, it should be considered a temporary measure only, with plans for complete surgical excision (Sistrunk procedure) after the infection resolves, typically in 4-6 weeks.
- The Sistrunk procedure, which involves removal of the cyst, the central portion of the hyoid bone, and the tract extending to the base of the tongue, remains a widely accepted treatment option for thyroglossal duct cysts, with a low recurrence rate 2, 3.
- However, the study by 1 found that incision and drainage of an infected thyroglossal duct cyst may not increase the risk of postoperative recurrence, which challenges the traditional view that incision and drainage should be avoided.
- It is essential to weigh the potential benefits and risks of incision and drainage in each individual case, taking into account factors such as the severity of symptoms, the presence of airway compromise, and the patient's overall health status. In terms of morbidity, mortality, and quality of life, the primary goal is to minimize the risk of recurrence and fistula formation while also ensuring the patient's safety and well-being. By considering the most recent and highest quality evidence available, clinicians can make informed decisions about the best course of treatment for each patient.