Infrahyoid Region Research Articles

Vagus Nerve's Topography in the Carotid Sheath: preliminary results

The knowledge of the vagus nerve's location within the carotid sheath is essencial in many surgical contexts, such as thyroidectomy. Intraoperative neuromonitoring may prevent iatrogenic nerve injury. There are only few studies about vagus nerve and its topography in the carotid sheath. This study aims to analyze the variation of the vagus nerve topography and its relation with the common carotid artery and the internal jugular vein, at the infrahyoid region.We dissected 10 carotid sheaths from 5 cadavers and the position of the vagus nerve and its relationship with the common carotid artery and the internal jugular vein were determined. Based on the carotid sheath cross‐section, the location of the vagus nerve was classified in four quadrants: between the common carotid artery and the internal jugular vein, but anterior to the carotid artery's cross section (A), between the common carotid artery and the internal jugular vein, but posterior to the carotid artery's cross‐section (B), posterior and medial to the carotid artery's cross section (C) and posterior and lateral to the internal jugular vein's cross‐section (D).We found 6 vagus nerve in position (A), 1 in position (B), 0 in position (C) and 3 in position (D).The knowledge of variations and their prevalence regarding the position of the vagus nerve as described in this preliminary study may contribute to avoid iatrogenic lesions in cervical surgeries.

English

Accessory muscles are rare anatomical variants which may have clinical implications. Variations of the muscles in the infrahyoid region assume clinical significance during diagnostic procedures and surgical operations in the region of neck. An unusual muscle Cleidohyoideus accessorius was found in the infra hyoid region bilaterally during routine dissection of neck region in an adult male cadaver. On both the sides muscle had its origin from the superior surface of the middle one third of the clavicle. The muscle coursing upward, lateral to the sternohyoid, was inserted into the hyoid bone. The other infra hyoid muscles including omohyoid were intact and in their typical form. The accessory muscle received its nerve supply from ansa cervicalis. Here we report a variation of rare occurrence, a case of bilateral accessory muscle Cleidohyoideus accessorius, its embryological and clinical considerations are being reviewed here.

A case of hemiagenesis of thyroid with double ectopic thyroid tissue

Developmental abnormalities of the thyroid gland are very rare. The most common abnormalities include ectopic thyroid tissues that are commonly seen in lingual or sublingual location, agenesis, and hemiagenesis of the thyroid gland. These developmental defects may or may not be associated with thyroid dysfunction. Our case is an 18-year-old male who presented with swelling in the neck of 4-year duration. Clinical examination revealed an oval-shape swelling in the left side of the thyroid gland. The ultrasound and the nuclear scan report revealed the presence of thyroid hemiagenesis of the right lobe with isthmus along with double ectopic thyroid tissue at suprahyoid and infrahyoid region. His thyroid function test showed elevated thyroid-stimulating hormone (TSH) and normal free T4. We report a very rare case of thyroid hemiagenesis with double ectopic thyroid tissue; and to the best of our knowledge, this is the first report in the world literature.

Valores referenciais da eletromiografia de músculos envolvidos na deglutição: uma revisão sistemática

TEMA: normalidade da eletromiografia de superfície de músculos envolvidos na deglutição. OBJETIVO: investigar se a literatura aponta valores referenciais de normalidade para a duração, amplitude e características dos eletromiogramas dos músculos envolvidos na deglutição (orbicular da boca, masseter, músculos da região supra-hióidea e músculos da região infra-hióidea cobertos pelo músculo platisma). CONCLUSÃO: a busca resultou em 33 referências, das quais somente cinco enquadraram-se nos critérios de inclusão. Apenas uma referência foi classificada com um bom nível de qualidade pela escala de Jadad com modificações. Os artigos selecionados podem não apontar valores referenciais confiáveis principalmente para a amplitude e morfologia da eletromiografia de superfície, pois utilizaram uma freqüência de amostragem inadequada para os registros eletromiográficos o que potencializa a obtenção de dados distorcidos da atividade muscular. Tendo em vista a variabilidade inter e entre os sujeitos, a literatura sugere a realização de técnicas de normalização do sinal eletromiográfico.

Ultrasound anatomy of the neck: The infrahyoid region

The infrahyoid region of the neck includes the visceral, anterior cervical, posterior cervical, carotid, retropharyngeal, and perivertebral spaces. The visceral space contains the thyroid, parathyroid glands, larynx, hypopharynx, the cervical trachea, and esophagus, the recurrent laryngeal nerve. The carotid space contains two parts, which extend from the skull base to the aortic arch and are delimited by the three layers of the deep cervical fascia (superficial, middle, and deep). It contains the internal carotid artery, the internal jugular vein, cranial nerves (IX–XII), the sympathetic plexus (suprahyoid compartment), the common carotid artery, the internal jugular vein, vagus nerve (infrahyoid compartment). The retropharyngeal space is a midlinespace containing adipose tissue that extends from the skull base to the upper mediastinum. It is located posterior to the pharynx and cervical esophagus, anterior to the danger area and the perivertebral space. The perivertebral space extends from the skull base to the clavicles and includes two parts: prevertebral and paraspinal. The prevertebral space includes the prevertebral muscles (long muscles of the neck and head), the scalene muscles (anterior, middle, and posterior), the roots of the brachial plexus, the phrenic nerve, the vertebral arteries and veins, and the vertebral bodies. The paraspinal space contains the paraspinal muscles and the posterior elements of the cervical spine. The posterior cervical space is a deep space located posterior to the sternocleidomastoid muscle. It contains the accessory nerve, the accessory chain lymph nodes, the pre-axillary component of the brachial plexus, and the dorsal scapular nerve. The anterior cervical space is located deep to the strap muscles and sternocleidomastoid muscle. It surrounds the front and sides of the visceral space and is related posteriorly to the carotid space. This article reviews the ultrasound features of the structures located in the infrahyoid region of the neck.

The laryngeal fat body

To describe the anatomy and topography of the laryngeal fat body and of the space it lies within. The study is carried out on series of histological sections of head and neck blocks from six foetuses and three newborns. Three adult necks were dissected, a fourth one analysed through sagittal median section. CT-Scan and MRI imaging complete the description. The laryngeal fat body (LFB) lies within the pre-epiglottic (PE) space that stands in the median anterior part of the upper infrahyoid region, located just below the level of the hyoid bone. The walls of the PE space are: superior (base), anterior lateral right and left, posterior, inferior (apex). This space is divided into two compartments by a median septum. The LFB consists in a rather pure fat, structured in large polyhedral lobules. It shows no limiting capsule. Dissection-based description of the PE space made in literature matches ours conducted on series of histological sections. All authors agree on the fat content of the space but some of them find a capsule around the LFB that we did not observe on our histological sections. CT-Scan and MRI imaging are accurate for analysis of these structures and of similar efficiency. The study of the LFB should be considered regarding the one of other fat bodies in the human body. Anatomical knowledge of the PE space and its content, the LFB, is important, as alteration of their morphology is the early witness of neighbouring carcinological extension.

入院加療を行った深頸部膿瘍例の検討

We reviewed 42 cases of deep neck abscess drained surgically or treated conservatively between February 2001 and August 2008, based on age, gender, primary focus, main symptom, abscess location, systemic disease, pathogenic bacteria, hospital treatment, hospitalization length, complications and long-term hospitalization. Of the 42, 26 were men and 16 women aged 14 to 80 (central age: 54.5 years). Abscess was caused most by tonsil inflammation (38.1%). Main symptom were sore throat (54.8%) and neck swelling (35.7%). Abscesses were found in the supra- and infrahyoid region in 30 cases and extended to the mediastinum in 2. Of the 42, 14 (33.3%) had hypertension and 11 (26.2%) diabetes mellitus (DM). Inflammation was due to aerobic bacteria (mainly Streptococcus milleri) in 23 cases (54.8%) and to anaerobic bacteria (mainly Peptostreptococcus) in 11 cases (26.2%). Flexible fiberscopic examination was important in evaluating pharyngeal and laryngeal mucosal disorders and enhanced computed tomography was useful in both diagnosis and postoperative observation. Of the 42, 38 required surgical drainage and 4 were cured using needle aspiration and antibiotics. Of the 38 undergoing surgery-tracheostomy was required in 22. Hospitalization for those with tracheostomy and DM was longer than in those without these factors. Complications included 2 cases each of, mediastinal abscess, sepsis, disseminated intravascular coagulation (DIC), acute renal failure, severe pneumonia, upper digestive tract bleeding and swallowing disorder. Early surgical drainage and intravenous antibiotic administration are thus essential for treating deep neck abscesses.

Diagnosis and surgical treatment of cervical lymphangioma

To discuss the methods of surgical treatment and their timing choices of cervical lymphangioma. A retrospective review of 53 patients with cervicofacial lymphangioma were treated surgically from July 1990 to December 2008. The age at operation was from 6.5 months to 41 years old (median age was 2 years old and 3 months). Eighteen (34.0%) lesions were located in the suprahyoid region and 35 (66.0%) lesions in the infrahyoid region. The diameter of lesion ranged from 3.3 to 8.2 cm (average: 4.4 cm). Neck mass was the sole symptom for 77.4% (41/53) cases. Nine patients presented with life-threatening complications including intracystic hemorrhage in 2 cases/times, infection and rapid increase in tumor size in 5 cases/times, dysphagia in 2 cases/times and respiratory obstruction in 4 cases/times. Color Doppler ultrasound was used to diagnose all patients pre-operatively. Computed tomography (CT) was used in 11 cases and magnetic resonance imaging (MRI) in 21 cases for differential diagnosis. The patients were treated by complete resection in 34 cases and subtotal resection in 8 cases. But partial resection in 11 (20.8%) cases developed a residual or recurrent lesion within 9 months to 5 years post-operation, including 7 cases in suprahyoid region and 4 cases in infrahyoid region. The rate of residual or recurrent lesions was significantly higher in the suprahyoid region (7/18) than that in the infrahyoid region (4/35) (chi(2) test, P < 0.05). The peri-operative complications were paralyses of mandibular branch of facial nerve, Horner's syndrome, secondary hemorrhage, fluid collection at resection site, local infection and parotid fistula in 1 case respectively. Respiratory distress caused by edema of tongue was present in 2 cases. All of them were cured conservatively. The pathological diagnosis was confirmed as capillary lymphangioma in 19 cases and cystic lymphangioma in 34 cases. The localization and extent of cervical lymphangioma are the most important determining factors for a successful surgical resection. Although complete excision is the ideal treatment for cervicofacial lymphangioma, this should not be attempted if lesions are too large and neighboring structures liable to injury. The surgeons should be aware of the limitations and potential surgical complications in certain instances.

Thyroglossal Duct Cyst Occurring in the Floor of the Mouth: Report of 2 Cases

Thyroglossal duct cysts, which are congenital neck masses in children, result from the embryologic remnants of the descending thyroglossal duct. After being enlarged by inflammation, infection, and mucous retention, they can be found anywhere in the midline of the neck between the foramen cecum and thyroid gland and are usually located in the infrahyoid region (85%)1 or in close proximity to the hyoid bone. In a previous text the location of thyroglossal duct cysts was classified as suprahyoid (20%), at the level of the hyoid bone (15%), and infrahyoid (65%).

The imperative of the Sistrunk operation: Review of 160 thyroglossal tract remnant operations

Analysis of the pre- and postoperative features, long-term follow-up, and complications. Case series with chart review of 160 thyroglossal tract remnant excisions over a 20-year period (1988-2007). The mean age of diagnosis was 10.9 +/- 14.2 years with 63.8 percent male predominance. There was a prior history of thyroglossal tract remnant infections in 70 percent of patients, and 30 percent presented with cutaneous fistulas. The majority had ultrasound imaging that identified cysts mainly (66.7%) in the infrahyoid region. Preoperative fine-needle aspirations in 18 patients were benign. On pathological reevaluation, 26.5 percent had thyroid tissue inside the remnant, with one case of papillary carcinoma. After the Sistrunk operation, postoperative complications occurred in 7.5 percent including a 1.9 percent recurrence rate. All age groups had similar clinical presentations and outcomes. Ultrasound is a reliable and appropriate imaging modality for most patients. Surgery must effectively incorporate the tract and cyst to allow low recurrence rates (<2%). Clinically diagnosed thyroglossal tract remnant may, in fact, be other pathologies in 10 percent of cases. Nevertheless, our recommendation is a Sistrunk procedure for all midline neck lesions suspected to be a thyroglossal tract remnant.

深頸部感染症

Deep neck infection (DNI) is an emergent otolaryngologic disease. We examined 69 patients, 52 males and 17 females, with DNI, who were treated in our hospital between 1995 and 2004. The mean age of DNI patients is 50.0 years old and peak incidence is in the sixth decade. Twenty patients suffered from diabetes mellitus (DM). The primary lesion of DNI was found in the tonsils in 34 cases, the oral cavity in 16 cases, the pharynx in 12 cases, and other regions in 7 cases, respectively. Among 69 DNI patients, infection remained in the suprahyoid region in 31 cases, whereas it extended to the infrahyoid region in 33 cases and to the mediastinum in 5 cases. The titer of serum C-reactive protein (CRP) and the duration of admission were considered parameters of DNI severity. CRP was significantly higher and the duration of admission was significantly longer in elderly patients, in patients with DM, and in patients with infrahyoid and mediastinal DNI, whereas no significant difference was found between males and females, and among the primary lesions. Therefore, we consider that age, DM, and the extension of DNI are important factors determining the severity of DNI. We also refer to the etiology, diagnosis, treatment and complications of DNI.

深頸部感染症６９例の臨床的検討

Deep neck infection (DNI) remains an emergent and life-threatening otolaryngologic disease. We examined 69 patients, 52 men and 17 women, with DNI, who were treated in our hospital between January 1995 and December 2004. The mean age of the patients with DNI was 50.0 years and the peak incidence was in the sixth decade. Twenty patients suffered from diabetes mellitus (DM). The primary DNI lesion was found in the tonsils in 34 cases, the oral cavity in 16 cases, and the pharynx in 12 cases, respectivelys. Among the 69 patients with DNI, the infection remained in the suprahyoid region in 31 cases, but it extended to the infrahyoid region in 33 cases and to the mediastinum in 5 cases. The titer of C-reacting protein (CRP) and the duration of admission were considered as parameters of the severity of DNI. CRP was significantly higher in elderly patients, in patients with DM, and in patients whose infection extended to the infrahyoid region and to the mediastinum, however, significant difference was not found between men and women, or among the types of primary DNI lesions. Moreover, the duration of admission was significantly longer in elderly patients, in patients with DM, and in patients with infrahyoid and mediastinal DNI, whereas no significant differences were found between men and women or among the types of primary lesions. Therefore, age, DM, and the extension of DNI are considered to be important factors which determining the severity of DNI.

Surgical Treatment of Cervicofacial Cystic Hygromas in Children

Aim: The aim of this study was to evaluate the results of surgical treatment of cervicofacial cystic hygromas in children. Patients and Methods: Medical records of 17 patients who were operated for cervicofacial cystic hygroma between 1985 and 2004 were evaluated in terms of age, gender, symptoms, diagnostic workups, outcomes and complications. Results: There was a slight male predominance – 10 (59%) boys and 7 (41%) girls. Nine (53%) out of 17 lesions were located on the left side of the neck, 7 (41%) lesions were located on the right side of the neck and 1 lesion (6%) was located in the middle of the neck. Eleven (65%) lesions were located in the infrahyoid region, 6 (35%) lesions in the suprahyoid region. Following surgical excision of the lesion, we encountered 4 postoperative complications: 1 recurrence (6%), 2 facial paralyses (12%) and 1 collection of fluid (6%) at the resection site. The patient who had a recurring lesion needed to be reoperated, other complications were treated conservatively. Conclusions: Cervicofacial cystic hygromas are easy to diagnose. There is no need for expensive and time-consuming imaging studies. Surgery seems the treatment of choice. However, nonsurgical treatment options may be considered for the lesions located over the parotid region in order to avoid complications of surgery.

Anatomie chirurgicale de la loge submandibulaire

Submandibular fossa refers to an incompletely closed osteo-fascio-cutaneous space surrounded by the oral floor, supra- and infra-hyoid regions, carotid region and mandibular area. It is a prismatic triangle of which inferior-lateral wall constitutes the surgical approach. The mandible constitutes its superior-lateral wall and the medial muscular wall features neurovascular elements. Anterior and posterior walls correspond to both poles of the submandibular gland. The submandibular fossa includes essentially the submandibular gland and neurovascular elements (facial vessels, lingual veins, lingual and hypoglossus nerves, lingual artery). The surgical approach of submandibular fossa successively crosses skin, sub-cutaneous cellular tissue, SMAS, fat tissue and superficial layer of superficial cervical fascia featuring facial vein.

Suprahyoid spaces of the head and neck.

W rHEN ONE refers to the deep spaces of the neck, one includes all of the tissue outside the aerodigestive system mucosal and submucosal structures. The major lesions of the aerodigestive mucosal space (AMS) are surface epithelium neoplasms. Squamous cell carcinomas (SQCCA) account for most AMS neoplasms, and in concert with minor salivary gland neoplasms and lymphoma of Waldeyer's ring, they comprise over 95% of the neoplasms of the AMS. Thus, there is a reasonably limited differential diagnosis for masses of the AMS. In contrast, the variety of lesions found in the deep spaces of the head and neck is astounding, and one is required to include spread of AMS lesions to the deep spaces with one's differential diagnoses. The classification of regions of the deep spaces is not wholly arbitrary, yet engenders some controversy amongst head and neck radiologists. For the radiologist who is not reading head and neck cases on a daily basis, the model derived from the works of Harnsberger, Osborne, and Smoker TM serves as the most practical approach. This model divides the nonmucosal spaces of the neck into regions defined by layers of the deep cervical fascia. The deep cervical fascia has superficial, middle, and deep layers, and these layers, in effect, form the boundaries for different spaces of the head and neck. One separates the neck into the suprahyoid and infrahyoid compartments because of the termination of some of the spaces at the hyoid level. In the suprahyoid region, the spaces of the neck include the masticator space, the prestyloid parapharyngeal space (PPS), the post-styloid parapharyngeal space or carotid space, the parotid space, the retropharyngeal space, and the perivertebral space. In the infrahyoid region, the visceral space (encompassing the trachea, esophagus, thyroid and parathyroid glands) comes into play, whereas the masticator space, the PPS, and the parotid space are no longer present. The carotid space, retropharyngeal space, and the perivertebral space span the suprahyoid and infrahyoid compartments. Before analyzing these spaces, it is helpful to understand how to localize a lesion to a particular space. Central to the suprahyoid spaces is the prestyloid parapharyngeal space, which is relatively unique among the spaces because its major component is fat. It is also the most mobile of the spaces of the head and neck because it is incompletely ensheathed by the deep cervical fascia. Most head and neck radiologists use the displacement of the PPS to help decide in which space a lesion resides. 5,6 Thus if the PPS fat is pushed posteromedially by a mass, the assumption is that the lesion arose in the masticator space. If the fat is pushed posterolaterally, an AMS mass is suspected. If the mass is pushed anteriorly or anteromedially with predominantly an anterior direction, a carotid space lesion is the likely culprit. (Distinguishing a pre-styloid process mass from a post-styloid carotid space mass requires visualization of the styloid process by computed tomography (CT) and the styloid musculature by magnetic resonance imaging [MRI]). If there is predominantly a medial displacement with some anterior component, a deep lobe parotid mass is the likely source. A retropharyngeal lesion will usually push the PPS fat anterolaterally. A perivertebral lesion may not affect the fat at all, but if it does, there will usually be an anterior component of displacement. The second important structure in the neck for localizing lesions is the longus colli musculature complex. When these muscles are displaced posteriorly, the lesion is usually arising from the AMS or the retropharyngeal space. If displaced anteriorly, a perivertebral source is indicated. The muscles themselves are part of the perivertebral space so an intrinsic longus colli mass is within the perivertebral space. At this point, an analysis of each space may help to gain confidence in diagnosing deep space lesions.

Ultrasonographic anatomy of the anterior neck: Implications for tracheostomy

Purpose: Tracheostomy is the preferred intervention for surgical establishment of an upper airway in the treatment of certain elective maxillofacial procedures. Complication rates associated with surgical tracheostomy are largely related to the restricted possibilities in diagnosis of anatomic variations. Therefore, endoscopic-guided tracheostomy is increasingly being used to enhance precision and safety. The purpose of this study was to assess the ultrasonographic anatomy of the anterior neck with regard to the performance of tracheostomy. Patients and Methods: Fifty patients underwent Ultrasonographic investigation to analyze the relationship of anatomic structures lying in the immediate vicinity of the tracheostomy site. Results: The data presented demonstrate the feasibility and advantage of preoperative ultrasonography to visualize the structures of the infrahyoid region. Conclusion: Preoperative ultrasonography may be of great importance in diagnosing individual anatomic variations at the site of tracheostomy and in avoiding complications.

Infra‐Hyoid Metastases in Supra‐Hyoid Squamous Cell Carcinoma

The CT scans of 71 patients with primary squamous cell tumours of head and neck sites were reviewed and compared with clinical examination in the assessment of lymph nodes above and below the hyoid. Above the hyoid, CT and clinical examination disagreed on the presence or absence of metastases in 13/42 cases (31%); below the hyoid where palpation is presumably easier, there was disagreement in 1 of 10 cases (10%). Abandoning infra-hyoid scans to save scanner time would save only seven slices on average per case and it is possible that further, clinically silent lesions would be missed. We conclude that staging scans in head and neck cancer should continue to include the infra-hyoid region. The inadequacies of existing knowledge based on clinical staging are discussed.

Muscular and other abnormalities in a case of Edwards' Syndrome (18‐trisomy)

This paper describes the anatomical variations observed in a specimen exhibiting Edwards' Syndrome (18-trisomy). The clinical and autopsy data are compared with those reported in earlier literature. Aside from having a tracheoesophageal fistula, the viscera were characterized by abnormalities of the heart, lungs, liver and kidneys. The facial musculature was relatively undifferentiated. Only a few abnormalities were recorded in the otomandibular and suprahyoid structures. The infrahyoid region had three pairs of supernumerary muscles, including the "sternohyoideus azygos." The bluk of abnormalities were found in the muscles and nerves of the upper limb. These included the absence of the palmaris longus and brevis, the subclavius and the extensor digiti quinti proprius; the presence of supernumerary muscles, e.g., the "rhomboideus occipitalis," the "latissimocondyloideus," and the "subclavius posticus." The deltoid and the pectoralis major were fused to form the "deltopectoral" complex. A definitive musculocutaneous nerve was found in the right arm only. In the lower extremity supernumerary muscles included the "tenuissimus," "peroneus quinti digiti," and the "extensor primi internodii hallucis."

The afferent innervation of two infrahyoid muscles of the cat.

1. The afferent innervation of the straplike muscles of the infrahyoid region were investigated in two ways. The morphology of spindles and counts of tendon organs were investigated by the gold chloride technique in ten muscles. Spindle counts were made in forty pairs of thyrohyoid and infrahyoid muscles. De-efferenting of the nerves to these muscles was done in three cats and the calibre spectra of the afferent innervation investigated. These were compared with the total counts of fibres in intact nerves.2. In the thyrohyoid, spindles are frequently absent. No tendon organs were seen. In the large infrahyoid (combined sternohyoid and sternothyroid), spindle counts varied from 0 to 20 and the mean spindle count per gram of muscle was 3.5. A maximum of five tendon organs were seen in the muscle. Both spindle and tendon organ counts are low when compared with a limb muscle of similar weight and size.3. In the infrahyoid muscle complex spindles were about equal in number to simple spindles.4. Counts of spindles in the infrahyoid muscle in families of three or more siblings suggest that some families of kittens tend to have higher spindle counts than other families.5. The afferent innervation of the two muscles varied between 21 and 42% of the total fibre population and the fibre diameter spectrum is in keeping with the low counts of encapsulated endings.

CLINICAL PRESENTATION AND SURGICAL TREATMENT OF THYROGLOSSAL DUCT ANOMALIES (TGDAS).

Objectives: To study the profdes of patients presenting with Thyroglossal duct anomalies and the outcomeof their surgical treatment.Study Design: Descriptive.Setting and duration of the study: Saidu Teaching Hospital Saidu Sharif Swat, from November 2005 toNovember 2006.Patients and methods: All patients were admitted through Out- patient department. They were analyzed onthe basis of location, age, sex, clinical presentation, operative findings, surgical procedure performed andduration of follow up. All the operations were done by the fellows of Oto-rhino-laryngology.Diagnosis was based on clinical examination in all cases. Ultrasound was carried out in all the patients tolocalize thyroid gland.Thyroid isotope scan and fistulogram are necessary preoperatively to find outfunctioning ectopic thyroid tissues and to see the extant of the tract. These investigations were not carriedout due to poor socioeconomic condition of the patients. Histopathological study was done in all the casesResults: A total of fifteen patients with clinically suspected thyroglossal duct anomalies were admitted fromNovember 2005 to Nov 2006. Out of the fifteen patients, one was female while the 14 cases were male.Age of the patients ranged from 2-16 years. Ten patients were below 8 years of age while 05 patients wereabove 8 years. Majority (53.5%) presented with neck swelling followed by discharging fistula (33.3%). Allpatients presented with midline swelling except one on the left side. Majority of swellings, i.e. 66% werepresent in the infra-hyoid region, while 26% presented at the pre-hyoid area. Per-operative findingsincludes 07 cases with tract up to the hyoid, 3 up to the tongue base, 3 tract attached to the hyoid bone, oneup to thyro-hyoid membrane, while in one case no tract was found.Conclusion; It is concluded from our study that most of the patients were below 8 years of age; malechildren were predominantly affected and majority of them presented with cystic swelling on one side ofneck.In 10 patients, the anomalies were situated in the infrahyoid region.No recurrence occurred viaperforming standard Sistrunck procedure at one year follow up.Key words; Key words: Thryoglossal duct anomalies, Sistrunk operation