From the Research
The treatment of choice for a thyroglossal duct cyst is complete surgical excision via the Sistrunk procedure, as it significantly reduces recurrence rates and is considered the gold standard treatment. This operation involves removing the cyst, the central portion of the hyoid bone, and the tract leading to the base of the tongue. Surgery is recommended even for asymptomatic cysts to prevent future infection, potential malignant transformation (though rare), and cosmetic concerns. The Sistrunk procedure is preferred over simple cyst excision because it significantly reduces recurrence rates from approximately 50% to less than 10% 1, 2, 3.
Key Considerations
- Preoperative evaluation should include thyroid function tests and imaging (ultrasound or CT scan) to confirm normal thyroid tissue is present elsewhere, as the cyst may contain the only functioning thyroid tissue in some patients.
- Antibiotics (such as amoxicillin-clavulanate 875/125 mg twice daily for 7-10 days or clindamycin 300 mg four times daily if penicillin-allergic) may be prescribed for infected cysts before surgery to control acute infection, but antibiotics alone are not curative.
- Recovery typically takes 1-2 weeks, with patients usually able to return to normal activities within this timeframe.
- The procedure is generally performed as outpatient surgery under general anesthesia and carries minimal risk of complications when performed by experienced surgeons 4.
Surgical Technique
The Sistrunk procedure, as described in the literature, involves the removal of the cyst, the central portion of the hyoid bone, and a core of tissue in the suprahyoid region up to the foramen caecum 5. This technique has been shown to be effective in reducing recurrence rates and is considered the standard of care for thyroglossal duct cysts.
Recent Evidence
A recent study published in 2019 found that the Sistrunk procedure is significantly superior in reducing the risk of cyst recurrence compared to other surgical treatments, with a recurrence rate of 11.5% 1. Another study published in 2016 highlighted the importance of performing the Sistrunk procedure correctly, with a recurrence rate of less than 3% when performed by experienced surgeons 3.