ABSTRACT
Thyroglossal cysts are congenital remnants of the thyroid gland as it migrates through the neck from its embryological origin at the foramen caecum, through the hyoid bone to its final anatomical position. Over 25% of thyroglossal cysts are not in the classical midline position. Infection in neck cysts must be managed with an understanding of the underlying diagnosis. Deep neck space abscesses have a significant mortality even with appropriate broad-spectrum antibiotics and drainage of the localised pus. The risk of recurrence of thyroglossal cysts is increased by factors if resection is undertaken in the face of infection and thus only simple drainage is recommended. Children, whose immune system is compromised by HIV, are at significant risk of developing opportunistic infections due to M. avium complex. Despite clinical signs suggestive of fluctuant suppurative adentitis, surgical drainage will only lead to chronic sinus formation and in this situation the most appropriate therapy is bimodal antimicrobial therapy of clarithromycin plus ethambutol or azithromycin.
