What is the initial management for a child with an infected thyroglossal duct cyst (TGDC) with abscess?

From the Guidelines

The initial management of a child with an infected thyroglossal duct cyst (TGDC) with abscess involves prompt administration of broad-spectrum antibiotics, such as cefazolin and clindamycin, for 10-14 days, as recommended by the Infectious Diseases Society of America 1. The choice of antibiotics should include coverage for common oropharyngeal organisms, as well as methicillin-resistant Staphylococcus aureus (MRSA), which is a common cause of skin and soft tissue infections 1. Surgical drainage of the abscess is also essential to remove purulent material and reduce pressure symptoms, and can be done via needle aspiration or formal incision and drainage, depending on the size and location of the abscess 1. Following resolution of the acute infection, definitive treatment with Sistrunk procedure (complete excision of the cyst, tract, and central portion of the hyoid bone) should be planned after a 4-6 week interval to allow inflammation to subside, as recommended by the World Journal of Emergency Surgery 1. Some key points to consider in the management of infected TGDC with abscess include:

• Prompt administration of broad-spectrum antibiotics, such as cefazolin and clindamycin, for 10-14 days 1
• Surgical drainage of the abscess to remove purulent material and reduce pressure symptoms 1
• Definitive treatment with Sistrunk procedure after a 4-6 week interval to allow inflammation to subside 1
• Supportive care, including pain management with acetaminophen or ibuprofen and adequate hydration, during the acute phase 1
• Close follow-up to monitor response to treatment and plan for definitive surgery 1

From the Research

Initial Management for Infected Thyroglossal Duct Cyst (TGDC) with Abscess

The initial management for a child with an infected thyroglossal duct cyst (TGDC) with abscess involves several considerations, including:

• The need for antibiotic treatment to manage the infection before proceeding with surgical intervention
• The role of incision and drainage (I & D) in the management of the abscess
• The definitive treatment approach, such as the Sistrunk procedure, which involves excision of the cyst, the tract connecting it to the foramen cecum, and the central portion of the hyoid bone

Treatment Options

The following treatment options are considered:

• Broad spectrum antibiotic treatment: Administration of broad-spectrum antibiotics, such as Cefazolin and Clindamycin, for 10-14 days to manage the infection 2
• Incision and drainage (I & D): I & D may be necessary to manage the abscess, but it may not increase the risk of postoperative recurrence 3
• Sistrunk procedure: The recommended definitive treatment for TGDCs, which involves excision of the cyst, the tract connecting it to the foramen cecum, and the central portion of the hyoid bone 4, 5
• Excision: Excision of the cyst may be necessary, but it is typically performed as part of the Sistrunk procedure

Recommendations

Based on the available evidence, the initial management for a child with an infected TGDC with abscess may involve:

• Broad spectrum antibiotic treatment to manage the infection
• Incision and drainage (I & D) if necessary to manage the abscess
• Definitive treatment with the Sistrunk procedure after resolution of the infection 2