The principle of the surgery is to remove the cyst along with its tract and the tissues surrounding it including part of the hyoid bone to reduce rate of recurrence of the cyst.
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| The embryological pathway for the descent of the thyroid gland starting from the foramen caecum, crossing the hyoid bone. |
The patient is placed in supine position. A transverse cervical incision is made along the hyoid bone. The cyst and tract is mobilized. A portion of the hyoid bone, about 1 cm each side form the midline is excised after releasing the hyoglossus and mylohyoid muscles. Tissues surrounding the ducts are excised up to the foramen caecum of the tongue. No attempts are made at separating the ducts from the tissue as Sistrunk noted that the duct are friable and easily broken. The defects are then approximated including the cut hyoid bones.
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| Cyst with parts of the ducts proximal to it. |
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| On the right is the excised TGDC with a part of the excised hyoid bone and proximal tissues on the left. |
Recurrence is about 10% after surgery. Wider excision is recommended for a recurrent cyst. Infected cysts are best drained or treated with antibiotics before proceding with surgery.
References:
1. Sistrunk, W. E., The Surgical Treatment of Cyst of the Thyroglossal Tract, Reprinted from Ann Surg 1920.
2. Coran, Arnold G., et al., Pediatric Surgery, 7th Ed., Elsevier
3. Pictures from various sites as linked.
Other Topics:
- Neck masses in children
- Embryology of the brachial arches
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