A 6-year-old boy has a 2 cm midline neck swelling that moves upward on swallowing and on protrusion of the tongue. It has repeatedly discharged through a small sinus. The correct operative procedure is:
- A Simple excision of the cyst and tract
- B Incision and drainage followed by antibiotics
- C Excision of the cyst with the central portion of the hyoid bone and the tract up to the foramen caecum ✓
- D Total thyroidectomy with central compartment node dissection
Correct answer: C. Excision of the cyst with the central portion of the hyoid bone and the tract up to the foramen caecum
Explanation
The swelling is a thyroglossal cyst, which characteristically moves with deglutition and tongue protrusion because of its attachment to the hyoid via the thyroglossal duct. The Sistrunk operation removes the cyst, the entire duct, the central portion of the body of the hyoid bone, and a core of tissue up to the base of the tongue. Simple excision leaves duct remnants within or deep to the hyoid and carries recurrence rates approaching 40 percent, which is why option A is wrong.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.