A 35-year-old presents with a soft, compressible, translucent midline neck swelling that moves upward with tongue protrusion and swallowing. It is located between the hyoid bone and the tongue base. The MOST appropriate definitive management is:
- A Sistrunk's operation — excision of cyst, its tract, central portion of hyoid bone, and core of tissue up to foramen caecum ✓
- B Excision of the cyst with its tract only
- C Marsupialization of the cyst
- D Aspiration and sclerotherapy with doxycycline
Correct answer: A. Sistrunk's operation — excision of cyst, its tract, central portion of hyoid bone, and core of tissue up to foramen caecum
Explanation
The description is a thyroglossal duct cyst (TGDC). The Sistrunk operation is the gold-standard definitive treatment, which includes excision of the cyst along with its fibrous tract, the central portion of the hyoid bone (to which the tract is intimately adherent), and a core of tongue base tissue up to the foramen caecum. Simple cyst excision alone has a recurrence rate >50%, while Sistrunk's procedure reduces recurrence to <5%. Movement with tongue protrusion is pathognomonic.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.