From 1970 to 1985, 64 patients underwent surgical management for thyroglossal duct cysts at the University of Oklahoma Health Sciences Center. Their ages ranged from 1 to 63 years with a mean of 12.4 years. Ninety-one percent of the patients were available for follow-up. All patients underwent one of three forms of treatment: the classic Sistrunk operation, a modified Sistrunk operation, or excision of the cyst only. Eleven percent had undergone a previous procedure. The majority of patients were found to have a cyst in the midline at the level of the hyoid bone. Eighty-eight percent of the patients underwent excision of the midportion of the hyoid bone. There were no postoperative deaths and the perioperative complication rate was 20 percent, the majority being wound-related. All recurrences took place within 4 months of operation. Factors that appeared to be associated with an increased risk of complications and recurrence included young patient age (less than 10 years), rupture of the cyst at the time of operation, infection, and failure to excise the midportion of the hyoid bone and the suprahyoid tract. One patient was found to have a mixed papillary and follicular carcinoma in the thyroglossal duct. We support the original premise of Sistrunk that "the cure of thyroglossal cyst are unsuccessful unless the epithelium-lined tract, running from the cyst to the foramen cecum is completely removed," including the hyoid bone.