What is the definitive surgical treatment of a thyroglossal duct cyst, and why?
- A Simple excision of the cyst, because recurrence depends only on complete cyst removal
- B Incision and drainage followed by sclerotherapy, to preserve the hyoid bone
- C Excision of the cyst with the central portion of hyoid bone and a core of tongue base muscle up to the foramen caecum ✓
- D Total thyroidectomy, because the cyst communicates with the pyramidal lobe in all cases
Correct answer: C. Excision of the cyst with the central portion of hyoid bone and a core of tongue base muscle up to the foramen caecum
Explanation
Sistrunk procedure removes the cyst, its tract through the central hyoid, and a cuff of tongue musculature up to the foramen caecum. The tract usually passes behind or through the hyoid body, so leaving the hyoid or the suprahyoid tract leaves residual epithelium and recurrence rates rise from under five percent to well over fifty percent. Simple cyst enucleation alone is therefore inadequate, and drainage or sclerosis has no definitive role.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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Written and medically reviewed by the StethoPrep medical team.