A 6-year-old boy underwent excision of a thyroglossal cyst two years ago and now presents with a recurring discharging sinus at the midline of the neck that has failed two simple sinus excisions. What was most likely omitted in the original operation?

• A Excision of the anterior belly of digastric
• B Removal of the pyramidal lobe of the thyroid
• C Ligation of the inferior thyroid artery
• D Excision of the body of the hyoid bone ✓

Explanation

Recurrence of thyroglossal cysts and fistulas is almost always due to incomplete excision of the track through or behind the body of the hyoid bone. The tract passes intimately related to the hyoid, so simple excision of the cyst or sinus without removing the central portion of the hyoid leaves residual epithelium. The correct operation is the Sistrunk procedure, which en bloc removes the cyst, entire track, central hyoid body and a core of tongue base tissue.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.