A 25-year-old woman is found to have a midline fistula at the lower anterior neck that secretes mucoid fluid on swallowing. She has no signs of infection. This likely represents a patent thyroglossal duct. Surgical removal requires excision of which bone structure to prevent recurrence?
- A Thyroid cartilage lamina between cricothyroid membrane and thyroid notch
- B Cricoid cartilage arch
- C Symphysis menti of the mandible
- D Body of hyoid bone (central part — Sistrunk's operation) ✓
Explanation
The thyroglossal duct descends from the foramen cecum at the base of the tongue to the thyroid gland, passing through or closely related to the central body of the hyoid bone. Remnants of this duct form thyroglossal duct cysts or fistulae. Sistrunk's operation (1920) involves complete excision of the cyst/tract along with the central portion of the hyoid bone body and a core of tissue extending to the base of the tongue up to the foramen cecum. Without hyoid resection, duct remnants within the bone cause high recurrence rates (30-50% vs <5% with Sistrunk's). Moving the tongue (swallowing/protrusion) elevates the cyst — pathognomonic sign.
Reference: BD Chaurasia's Human Anatomy, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.