Thyroglossal Cyst Removal
The Sistrunk procedure is the definitive surgical approach for thyroglossal duct cyst removal, involving complete excision of the cyst, the central portion of the hyoid bone, and a core of tissue extending superiorly to the foramen cecum at the base of the tongue. 1, 2, 3
Preoperative Evaluation
Before proceeding with surgery, specific imaging and functional assessments are essential:
Perform neck ultrasound to confirm the presence of a normal thyroid gland in its anatomic position 1. This is critical because in rare cases, the cyst may contain the only functioning thyroid tissue.
Consider thyroid function testing if there is any concern about thyroid status or if ultrasound findings are equivocal 1.
Surgical Technique: The Sistrunk Procedure
The standard surgical approach involves three key components that must all be addressed to minimize recurrence:
Core Surgical Steps
Remove the thyroglossal cyst itself along with its entire tract 2, 3
Excise the central 10mm portion of the hyoid bone body 2, 4. The hyoid bone must be divided at its junction with the lateral horns bilaterally.
Resect a core of suprahyoid tissue extending from the hyoid bone superiorly to the foramen cecum at the base of the tongue 2, 5, 3. This deep tongue musculature dissection is what distinguishes the Sistrunk procedure from simple cyst excision and reduces recurrence from approximately 50% to 3-5% 3.
Technical Considerations
Use monopolar electrocautery to section the hyoid bone rather than bone-cutting forceps 4. This technique provides more precise control, ensures complete bone removal, and allows better access to the posterior hyoid space with minimal bleeding risk 4.
Maintain strict midline orientation throughout the dissection 6. The hyoid bone can override the thyroid notch in young children, and mistaking the thyroid cartilage for the hyoid bone can result in catastrophic airway injury requiring tracheotomy 6.
Ensure adequate exposure of the suprahyoid region to allow complete excision of the tract to the foramen cecum 5. Inadequate excision in this area is the primary cause of recurrence 5.
Expected Outcomes
Recurrence rates with proper Sistrunk technique are 0-8.8% 4, 5, compared to approximately 50% with simple cyst excision 3.
Average hospital stay is 3 days with minimal morbidity 2
No blood transfusion is typically required 2
Critical Pitfalls to Avoid
The most serious complication is airway injury from misidentifying the thyroid cartilage as the hyoid bone 6. If this occurs:
- Immediate laryngotracheoplasty with cartilage grafting is required 6
- Tracheotomy is necessary in all cases, with average decannulation time of 4.5 months 6
- Voice outcomes are poor in 75% of cases despite successful airway reconstruction 6
Prevention requires meticulous attention to midline cervical anatomy and proper identification of the hyoid bone before any bone cutting begins 6.