A 6-year-old girl has a painless midline neck swelling that has been present since infancy. The swelling moves up on swallowing and on protrusion of the tongue. Ultrasound confirms a normal thyroid in its orthotopic position. What is the most appropriate management?
- A Fine needle aspiration cytology followed by observation
- B Incision and drainage with a course of antibiotics
- C Excision of the cyst along with the central portion of the body of the hyoid bone ✓
- D Radioiodine ablation of the cyst
Correct answer: C. Excision of the cyst along with the central portion of the body of the hyoid bone
Explanation
This is a thyroglossal duct cyst, which moves with swallowing and tongue protrusion because of its attachment to the foramen caecum via the thyroglossal tract. Treatment is complete surgical excision by the Sistrunk procedure, which removes the cyst, the entire tract, and the central part of the hyoid bone because the tract passes through or just behind it. Excision without the hyoid carries a high recurrence rate. Aspiration or drainage alone leads to recurrence and infection.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.