Sistrunk Procedure


The Sistrunk procedure is the standard method for excision of a thyroglossal duct cyst. It involves removal of the entire pathway of the cyst, along with a cuff of surrounding tissue and a portion of the hyoid bone.

Indications for Surgery:

Thyroglossal duct cyst

Contraindications to Surgery:

  • Medical comorbidities that would preclude surgical or anesthesia risk
  • Surgery should be delayed until any infection has resolved with antibiotic therapy
  • Management of median ectopic thyroid (i.e., where all functional thyroid tissue would be removed during the procedure) is controversial

Pre-Operative Evaluation:

  • Thyroid ultrasound
  • Thyroid scintigraphy if there is evidence of hypothyroidism or no thyroid is seen in the neck on ultrasound


General endotracheal

Surgical Technique:

  1. The patient is placed supine on the operating table and general anesthesia is induced via endotracheal intubation.
  2. The table is rotated 180 degrees and a shoulder roll is placed under the patient.
  3. The incision site is injected with 1% lidocaine with 1:100,000 epinephrine, and a transverse skin incision is made at the level of the cricothyroid membrane.
  4. Subplatysmal flaps are elevated and dissection performed to delineate the cyst boundaries before proceeding medially to the hyoid.
  5. The strap muscles are dissected from the central one-third of the hyoid and bone cutters are used to mobilize the central portion of the hyoid bone.
  6. Dissection is carried out superiorly to the base of tongue, close to the foramen cecum, from where the tract originates.
  7. The tract is clamped, cut, and suture ligated, allowing the thyroglossal duct cyst, middle one-third of the hyoid, and the tract to be removed en bloc.
  8. Valsalva is induced with the assistance of the anesthesiologist, and hemostasis is achieved using bipolar electrocautery.
  9. The wound is irrigated and a drain may be inserted.
  10. The strap muscles are reapproximated to the tongue base, and the wound is closed in two layers.
  11. A sterile dressing is applied to the neck, and care of the patient is returned to the anesthesiologist for extubation and recovery.

Post-Operative Care:

  • Patients may be discharged on the day of surgery or monitored overnight depending on age, general health, and access to health care facility.
  • If present, the drain can typically be removed on postoperative day 1.
  • Diet may be resumed as tolerated, unless the pharyngeal mucosa was violated during the procedure.


  • Incomplete excision or cyst recurrence
  • Neck hematoma or seroma
  • Injury to local structures, including superior laryngeal, lingual, or hypoglossal nerves
  • Wound infection