From the Research
The diagnosis and treatment for a thyroglossal duct cyst involves surgical removal through a procedure called the Sistrunk procedure, which includes removal of the cyst, the central portion of the hyoid bone, and the tract leading to the base of the tongue, as this approach has been shown to reduce recurrence rates to about 5-10% 1.
Diagnosis
A thyroglossal duct cyst is a congenital anomaly that occurs when the thyroglossal duct, which forms during embryonic development, fails to completely disappear. The cyst appears as a painless midline neck mass that moves upward when swallowing or sticking out the tongue. These cysts develop from remnants of the thyroglossal duct, which normally atrophies after the thyroid gland descends to its final position in the neck.
Treatment
Treatment for a thyroglossal duct cyst typically involves surgical removal through the Sistrunk procedure. This operation is recommended even for asymptomatic cysts to prevent potential complications such as infection, enlargement, or rare malignant transformation. The Sistrunk procedure has been shown to be a safe and effective procedure, with low recurrence and morbidity rates 2, 3.
- The Sistrunk procedure includes removal of the cyst, the central portion of the hyoid bone, and the tract leading to the base of the tongue.
- Antibiotics like amoxicillin-clavulanate may be prescribed if the cyst becomes infected before surgery, but they are not a definitive treatment.
- Recent studies have also explored endoscopic approaches, such as the bilateral axillo-breast approach, which provides excellent cosmetic results and is a safe and better alternative for the successful treatment of TGDC 1.
- Without complete surgical excision including the central hyoid bone, recurrence rates are high, approximately 30-40%, whereas the Sistrunk procedure reduces recurrence to about 5-10% 3, 4.
Key Considerations
- The Sistrunk procedure is the treatment of choice for thyroglossal duct cysts because it yields low recurrence and morbidity rates 3.
- Postoperative infections, rather than preoperative infections, are associated with recurrence 3.
- Documentation of a normal thyroid preoperatively has become a legally protective requirement 5.
- Carcinoma in a TGDC is unusual and is rarely detected preoperatively, but a fine needle aspiration is helpful if a malignancy is suspected 5.