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 with significant cellulitis or systemic signs of infection, as seen in this case 1.
Treatment Approach
The management of a thyroglossal cyst with abscess formation involves a two-stage approach:
- Initial management of the acute infection
- Definitive surgical management once the infection has resolved
Initial Management
For the acute infection, incision and drainage is the primary treatment, as recommended by the Infectious Diseases Society of America for abscesses with significant cellulitis or systemic signs of infection 1. This approach is also supported by the 2018 WSES/SIS-E consensus conference, which recommends incision and drainage with adjuvant antibiotic therapy for complex abscesses 1.
Definitive Surgical Management
Once the infection has resolved completely, 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. This surgical approach is essential because simple incision and drainage or cyst excision alone results in high recurrence rates (up to 50%) 1.
Antibiotic Therapy
Antibiotic therapy may be necessary in cases where there are systemic signs of infection, immunocompromised patients, or incomplete source control. Empiric broad-spectrum antibiotic therapy with coverage of Gram-positive, Gram-negative, and anaerobic bacteria may be recommended 1.
Key Points
- Incision and drainage is the primary treatment for thyroglossal cyst abscesses with significant cellulitis or systemic signs of infection
- The Sistrunk procedure is the definitive treatment for thyroglossal cysts to prevent recurrence
- Antibiotic therapy may be necessary in certain cases, such as systemic signs of infection or immunocompromised patients.
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.