What is the most common complication after I&D of a thyroglossal abscess?

Management of Thyroglossal Duct Abscess: Complications After Incision and Drainage

Postoperative infection is the most common complication after incision and drainage of a thyroglossal duct abscess, which significantly increases the risk of recurrence. 1

Understanding Thyroglossal Duct Cysts and Abscesses

Thyroglossal duct cysts (TGDCs) are common congenital neck anomalies that can become infected and form abscesses. These typically present as:

• Midline neck masses that may become painful and tender
• Swelling that moves with swallowing or tongue protrusion
• Signs of infection including redness, warmth, and tenderness

Complications After Incision and Drainage

When analyzing the options presented in the question:

1. Recurrence - This is common but typically associated with inadequate surgical technique during definitive treatment (Sistrunk procedure), not after simple I&D
2. Postoperative infection - The most common immediate complication after I&D of thyroglossal abscess
3. Fistula formation - Can occur but less common than infection
4. Blind sinus - Less common than infection
5. Malignancy - Extremely rare complication

Evidence for Postoperative Infection as the Primary Complication

Research demonstrates that postoperative infection is the most significant complication following drainage procedures for thyroglossal duct abscesses:

• In a large series of TGDC cases, postoperative infection occurred in 13% of patients 1
• Postoperative infection was strongly associated with recurrence of disease (P<0.001) 1
• The most recent study (2025) confirms that postoperative infection is significantly associated with recurrence with an adjusted odds ratio of 11.98 2

Risk Factors for Complications

Several factors increase the risk of complications after thyroglossal abscess drainage:

• Male sex (adjusted OR = 3.26) 2
• Postoperative seroma formation (adjusted OR = 5.03) 2
• Inadequate drainage technique
• Failure to perform definitive treatment (Sistrunk procedure) after infection resolves

Management Approach After I&D

1. Initial management: Incision and drainage of the abscess with appropriate antibiotic coverage

2. Post-drainage care:

   • Close monitoring for signs of infection
   • Complete antibiotic course
   • Regular wound care and dressing changes
   • Follow-up ultrasound to assess resolution

3. Definitive treatment:

   • Once infection resolves, definitive treatment with Sistrunk procedure is recommended
   • Simple I&D without subsequent Sistrunk procedure has high recurrence rates

Prevention of Complications

To minimize the risk of postoperative infection and subsequent recurrence:

• Ensure adequate drainage of the abscess
• Appropriate antibiotic coverage for oral flora
• Consider placement of a drain in large abscesses
• Plan for definitive Sistrunk procedure after resolution of acute infection
• Close follow-up to monitor for early signs of infection

The evidence clearly shows that while recurrence is a concern with thyroglossal duct pathology overall, in the specific context of post-I&D complications, postoperative infection is the most common immediate complication and significantly increases the risk of subsequent recurrence 2, 1.