What is the best treatment for a thyroglossal cyst presenting with signs of abscess formation, such as pain, redness, and increased temperature?

From the Guidelines

The best treatment for a thyroglossal cyst presenting with signs of abscess formation, such as pain, redness, and increased temperature, is incision and drainage, as this approach is recommended for abscesses associated with severe or extensive disease, rapid progression, or signs and symptoms of systemic illness, as stated in the guidelines by the Infectious Diseases Society of America 1.

Key Considerations

• The primary treatment for a cutaneous abscess, including those associated with thyroglossal cysts, is incision and drainage, as recommended by the Infectious Diseases Society of America 1.
• Antibiotic therapy may be recommended in addition to incision and drainage for abscesses associated with severe or extensive disease, rapid progression, or signs and symptoms of systemic illness, as well as for patients with comorbidities or immunosuppression 1.
• The choice of antibiotic should be guided by the severity of the infection, the presence of systemic signs, and the results of cultures, if available, with empiric broad-spectrum antibiotic therapy recommended for complex abscesses 1.

Treatment Approach

• Incision and drainage should be performed to relieve pressure and obtain cultures, followed by broad-spectrum antibiotics such as amoxicillin-clavulanate for 7-10 days, if necessary.
• Once the infection has resolved, definitive treatment requires the Sistrunk procedure, which involves complete excision of the thyroglossal cyst, the tract, and the central portion of the hyoid bone to prevent recurrence.
• Patients should be informed that surgery is typically performed as an outpatient procedure with a recovery period of 1-2 weeks, and that delaying definitive surgical management after the infection resolves increases the risk of recurrent infections and potential complications.

Evidence Summary

• The Infectious Diseases Society of America recommends incision and drainage as the primary treatment for cutaneous abscesses, including those associated with thyroglossal cysts 1.
• The 2018 WSES/SIS-E consensus conference recommends antibiotic therapy for complex abscesses, including those with systemic signs of infection, immunocompromised patients, or incomplete source control 1.
• The guidelines emphasize the importance of individualizing treatment based on the patient's clinical response and the severity of the infection.

From the Research

Treatment Options for Thyroglossal Cyst with Abscess Formation

The best treatment for a thyroglossal cyst presenting with signs of abscess formation, such as pain, redness, and increased temperature, is a topic of discussion among medical professionals.

• The Sistrunk procedure is widely accepted as the main operation of choice for thyroglossal duct cysts, as it involves dissection of the tract and removal of the hyoid bone, which helps to limit recurrence 2.
• However, in cases where the cyst is infected and has formed an abscess, incision and drainage may be necessary to manage the infection before proceeding with the Sistrunk procedure 3.
• Some studies suggest that incision and drainage of an infected thyroglossal duct cyst may not increase the risk of postoperative recurrence 3.
• Antibiotic therapy may be used to manage the infection, but it is not always necessary, and hospital stay is often short 2.
• In some cases, admission for IV antibiotics may be necessary to manage severe infections, but this is not always the best initial treatment option.

Comparison of Treatment Options

• Oral antibiotics (Option A) may not be sufficient to manage the infection, especially if the cyst has formed an abscess.
• Incision and drainage (Option B) may be necessary to manage the infection, but it is not always the best initial treatment option.
• Hot fomentation (Option C) is not a recommended treatment option for thyroglossal cysts with abscess formation.
• Admission for IV antibiotics (Option D) may be necessary in some cases, but it is not always the best initial treatment option.

Recommended Treatment Approach

Based on the available evidence, the recommended treatment approach for a thyroglossal cyst presenting with signs of abscess formation is incision and drainage, followed by the Sistrunk procedure to limit recurrence 3, 2. However, the best course of treatment should be determined on a case-by-case basis, taking into account the individual patient's needs and circumstances.