When should thyroglossal duct cysts be removed?
During the embryologic development of the thyroid, a diverticulum forms from the foramen cecum at the base of the tongue and descends as the thyroglossal duct to the future anatomic position of the thyroid overlying the anterolateral surface of the upper tracheal rings. The thyroglossal duct normally disappears during further development but, in rare cases, will persist as a patent duct or as a thyroglossal duct cyst. Patients may experience infections, pain or compressive symptoms, or may have cosmetic concerns. Because of the risk of infection, thyroglossal duct cysts should be removed; this requires excision of the entire cyst and cyst tract from the origin at the foramen cecum down to the cyst itself. Because the tract nearly always passes through the hyoid bone, the center of the hyoid should be resected to lower the risk of recurrence; this causes no disability and requires no repair.