From the Research
The best treatment for a thyroglossal cyst presenting with signs of abscess formation is a two-stage approach, initially treating the abscess with antibiotics and possible incision and drainage, followed by definitive surgical excision via the Sistrunk procedure once the infection has resolved. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of complete surgical excision to prevent recurrence 1. The Sistrunk procedure, which includes removal of the cyst, its tract, and the central portion of the hyoid bone, is considered the gold standard for treating thyroglossal duct cysts due to its low rates of complications and recurrence.
Key considerations in the treatment of thyroglossal cysts with abscess formation include:
- Initial treatment with antibiotics to cover oral flora, such as amoxicillin-clavulanate or clindamycin for penicillin-allergic patients 1
- Possible incision and drainage if the abscess is severe, as this may not increase the risk of postoperative recurrence 2
- Delaying surgery until the acute infection has completely resolved to minimize the risk of surgical complications and recurrence 1
- The importance of complete surgical excision via the Sistrunk procedure to prevent recurrence, as simple cystectomy without hyoidectomy and pre-existing infection are main causes of recurrence 3
Overall, the two-stage approach of initial abscess treatment followed by definitive surgical excision via the Sistrunk procedure offers the best outcomes in terms of morbidity, mortality, and quality of life for patients with thyroglossal cysts presenting with signs of abscess formation.