Sistrunk Procedure (Thyroglossal Duct Cyst)
6028060281wRVU: 8.6 — Excision of recurrent thyroglossal duct cyst or sinus60240wRVU: 14.66 — Thyroidectomy (if concurrent, for TDCC carcinoma)
Thyroglossal duct cyst, midline neck [/ left / right of midline]
Same
Sistrunk procedure: excision of thyroglossal duct cyst with central hyoid bone resection and tract excision to foramen cecum
[Attending name], MD
[Resident name]
General endotracheal. Neck extended over shoulder roll.
Patient presents with a [X]-cm midline neck cyst inferior to the hyoid bone consistent with thyroglossal duct cyst. [Present since infancy / recent enlargement / prior infection / ultrasound confirmed.] [Thyroid gland confirmed normal on ultrasound in expected location.] [No prior excision / Prior excision at [date], recurrent.] Risks including recurrence (higher without hyoid resection), nerve injury, and wound complications discussed. Consent obtained.
Thyroglossal duct cyst [X] cm, midline, adherent to hyoid bone. Tract identified coursing superiorly through hyoid to base of tongue. Hyoid bone central segment [X] cm resected en bloc. Tract followed to foramen cecum and ligated. Cyst [intact / inadvertently entered (capsule intact and fully excised)].
The patient was positioned supine with the neck extended over a shoulder roll. The anterior neck was prepped and draped in sterile fashion.
A [transverse / elliptical] incision of [X] cm was made in a natural neck crease overlying the cyst, at or slightly below the hyoid bone level. Subplatysmal flaps were elevated superiorly and inferiorly. The cyst was identified in the midline and dissected free from the surrounding strap muscles and subcutaneous tissue, taking a cuff of tissue with the cyst.
The tract was followed superiorly to the hyoid bone. The central portion of the hyoid bone ([X] cm) was divided on each side with [bone cutters / electrocautery / Metzenbaum scissors]. The central hyoid segment was removed en bloc with the cyst.
The tract was followed through the base of tongue musculature toward the foramen cecum. A core of tongue base musculature was excised with the tract [under intraoral guidance with a finger placed in the floor of the mouth]. The tract was suture-ligated at the most superior extent with [2-0 Vicryl / 2-0 silk].
The specimen (cyst, central hyoid, and attached tract) was removed intact and sent to pathology. The wound was irrigated with saline. Strap muscles were reapproximated with [3-0 Vicryl]. Platysma closed with [3-0 Vicryl]. Skin closed with [4-0 Monocryl / 5-0 Monocryl]. Patient tolerated the procedure well.
None
Thyroglossal duct cyst with hyoid segment and tract to permanent pathology
Minimal
None
Patient to PACU. Discharged to home same day.
Epic SmartPhrase Version
PREOPERATIVE DIAGNOSIS: Thyroglossal duct cyst, midline neck
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Sistrunk procedure: excision of thyroglossal duct cyst with central hyoid resection and tract ligation at foramen cecum
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: General endotracheal, neck extended over shoulder roll
INDICATIONS: The patient is a .PTAGE-year-old .PTSEX with a *** cm midline neck cyst consistent with thyroglossal duct cyst. [Ultrasound confirmed normal thyroid in expected location.] [No prior excision / Recurrent (prior excision ***).] Risks including recurrence, nerve injury, and wound complications discussed. Informed consent obtained.
FINDINGS: Thyroglossal duct cyst *** cm, midline, adherent to hyoid. Tract followed superiorly through hyoid to foramen cecum. Central hyoid *** cm resected en bloc. Tract ligated at foramen cecum. Cyst excised intact.
DESCRIPTION OF PROCEDURE:
Patient supine, neck extended. Transverse incision *** cm in neck crease overlying cyst. Subplatysmal flaps elevated. Cyst identified and dissected from strap muscles with cuff of tissue. Tract followed to hyoid. Central hyoid *** cm divided bilaterally with bone cutters and removed en bloc with cyst. Tract followed through tongue base musculature toward foramen cecum. Core of musculature excised. Tract suture-ligated at most superior extent with 2-0 Vicryl. Specimen (cyst, hyoid segment, and tract) removed intact and sent to pathology. Wound irrigated. Strap muscles approximated with 3-0 Vicryl, platysma with 3-0 Vicryl, skin with 4-0 Monocryl. Patient tolerated procedure well.
ESTIMATED BLOOD LOSS: Minimal
SPECIMENS: Thyroglossal duct cyst with hyoid segment and tract to pathology
COMPLICATIONS: None
DRAINS: None
DISPOSITION: Patient to PACU. Discharged home same day.
Signed: .ME, .MYDEGREE
.TODAYVariants
Recurrent thyroglossal duct cyst
CPT 60281. Scar tissue from prior dissection increases difficulty and recurrence risk. Document prior surgery, adherence to scar, and wider excision of tongue base musculature. Intraoperative needle aspiration of the field can help identify residual tract.
Infected or previously drained cyst
Prior drainage or infection creates dense fibrosis. Complete excision may be more difficult; document increased complexity. Some surgeons stage the procedure (drain infection first, excise 4-6 weeks later when inflammation resolves).
Thyroglossal duct cyst carcinoma
Rare. Almost always papillary thyroid carcinoma. Sistrunk procedure is curative for most cases without gross extrathyroidal extension. Thyroid evaluation mandatory. Concurrent thyroidectomy considered if thyroid lesion present or per institutional protocol.
Charting Tips
- Confirm normal thyroid gland location preoperatively (ultrasound), as ectopic thyroid can mimic TGDC
- Document central hyoid bone length removed (typically 1-1.5 cm)
- State that tract was followed to foramen cecum and ligated; this is the key step that reduces recurrence
- Note cyst integrity. Intact excision is preferred. If entered, document and ensure all capsule is removed.
- For recurrent cases, document extent of prior excision and current dissection relative to prior scar
Billing Tips
- Bill 60280 for excision of thyroglossal duct cyst or sinus (8.28 wRVU, 90-day global). Bill 60281 for excision of recurrent thyroglossal duct cyst or sinus (10.05 wRVU). Use 60281 any time the patient has had a prior excision, regardless of how long ago or where it was performed. Document prior surgery explicitly.
- The Sistrunk procedure includes cyst excision, the central portion of the hyoid bone, and the tract up to the foramen cecum. This is all bundled in 60280/60281. Do not separately bill hyoid bone excision or tract dissection.
- If infection or abscess is present at the time of surgery, document it. This increases operative complexity and supports modifier -22 if the dissection is substantially more difficult than standard.
- 90-day global period: wound checks, suture removal, and routine follow-up are bundled. Recurrence requiring re-excision within 90 days uses modifier -78. Recurrence after 90 days uses 60281 (recurrent cyst code).
- Concurrent central neck dissection for thyroglossal duct cyst carcinoma (rare): document separately and bill appropriate neck dissection codes. Thyroglossal duct cyst carcinoma is almost always papillary. Thyroid evaluation and potential thyroidectomy should be documented in the plan.