Although the operation to remove thyroglossal cysts and their tracts is commonly performed, a full understanding of the possible anatomical locations of the tracts may be less appreciated. This article helps the reader understand the possible variations available which should be considered to keep recurrence rates as low as possible. It also delineates the presenting features and the suggested work-up prior to surgery. The descent of the thyroid is usually anterior to the hyoid but in 30% the duct may be posteriorly placed. Histologically there is still debate about whether the tract truly runs through the hyoid or in close proximity. Studies have also shown that it is not always a single tract and that several tracts distal to the hyoid may converge to a single duct at the cranial level of the hyoid, then may diverge again. The operative description is the author’s preference for the procedure and is fairly standard. However, it would have been useful had they included tips or tricks or a literature review of any other described alteration in technique to provide perspective. Further advice for the surgeon who acquires the patient with recurrent disease would have been welcomed – do they image them and if so with what and in what way does their technique change? Performing the procedure competently is one thing but effectively managing a complication is another. Nonetheless, the anatomical line drawings were helpful and the article was a useful summary.

Thyroglossal duct cyst: operative technique.
Newton SS.
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Suzanne Jervis

FRCS (ORL HNS), Shrewsbury and Telford Hospitals, NHS Trust, UK.

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