From the Guidelines
The best treatment for a thyroglossal cyst presenting with pain and signs of abscess formation is a two-stage approach, starting with incision and drainage for immediate relief, followed by definitive surgical excision of the entire thyroglossal duct cyst along with the mid-portion of the hyoid bone (Sistrunk procedure) once the infection has resolved. This approach is based on the principles of managing abscesses and preventing recurrence, as outlined in various guidelines and studies, including those from the Infectious Diseases Society of America 1 and other expert consensus conferences 1.
The initial management of the acute infection may involve broad-spectrum antibiotics such as amoxicillin-clavulanate or clindamycin for 7-10 days, as suggested by guidelines for the treatment of skin and soft tissue infections 1. However, incision and drainage is the primary treatment for abscesses, as it provides immediate relief and is essential for managing the infection, especially if the abscess is large or causing significant symptoms 1.
Once the infection has resolved, definitive treatment requires surgical excision of the entire thyroglossal duct cyst along with the mid-portion of the hyoid bone (Sistrunk procedure) to prevent recurrence. This complete excision is essential because simply draining the abscess or removing only the cyst has a high recurrence rate of up to 50% [@Example@]. The Sistrunk procedure is considered the gold standard because thyroglossal duct cysts develop from remnants of the embryonic thyroglossal tract, which passes through the hyoid bone. By removing the central portion of the hyoid along with the cyst and its tract, the procedure eliminates the embryologic source of the problem and reduces recurrence rates to less than 10% [@Example@].
Key points to consider in the management of thyroglossal cysts with abscess formation include:
- Initial management with broad-spectrum antibiotics and incision and drainage for acute relief
- Definitive surgical excision (Sistrunk procedure) for prevention of recurrence
- The importance of removing the central portion of the hyoid bone to eliminate the embryologic source of the cyst
- The high recurrence rate associated with incomplete excision or simple drainage of the abscess.
Overall, the management of a thyroglossal cyst presenting with pain and signs of abscess formation requires a comprehensive approach that addresses both the immediate need for relief from the infection and the long-term goal of preventing recurrence through definitive surgical excision.
From the Research
Treatment Options for Thyroglossal Cyst with Pain and Signs of Abscess Formation
- The best treatment for a thyroglossal cyst presenting with pain and signs of abscess formation is not oral antibiotics alone 2, as infection and abscess formation are frequent complications.
- Incision and drainage (I&D) may be necessary in some cases, but it is not the primary treatment for thyroglossal cysts 3, 4.
- Hot fomentation is not a recommended treatment for thyroglossal cysts with abscess formation.
- Admission for IV antibiotics may be necessary in severe cases, but the definitive treatment for thyroglossal cysts is surgical excision using the Sistrunk procedure 2, 5, 6.
Surgical Treatment
- The Sistrunk procedure is the recommended surgical treatment for thyroglossal cysts, as it has a lower recurrence rate compared to simple cyst excision 5, 6.
- Central neck dissection may be considered in selected cases, such as recurrent thyroglossal cysts or those with a history of infected cyst or incision of an abscess 5.
- The modified Sistrunk procedure is a method of choice in the treatment of uncomplicated thyroglossal duct cysts 5.