A 4-year-old boy has a midline neck swelling just below the hyoid that has enlarged after an episode of tonsillitis. The swelling moves on swallowing AND on protrusion of the tongue, and transilluminates poorly. Fine-needle aspiration yields mucoid fluid with cholesterol crystals. What is the correct management?

• A Excision of the cyst together with the central portion of the hyoid bone and the tract up to the foramen caecum ✓
• B Incision and drainage followed by antibiotics
• C Total thyroidectomy because the cyst represents an accessory thyroid lobe
• D Sclerotherapy with absolute alcohol under ultrasound guidance

Explanation

Movement on both swallowing and tongue protrusion identifies a thyroglossal duct cyst, remnants of the thyroglossal duct descending from the foramen caecum. Simple excision or drainage recurs almost invariably because epithelial remnants persist along the tract. The Sistrunk procedure removes the cyst, the entire tract, the central portion of the hyoid bone (through which the tract passes), and tissue up to the foramen caecum, reducing recurrence to under 5 percent. Squamous or papillary carcinoma rarely arises within these cysts, another reason for complete excision.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.