Thyroglossal duct cysts occur along the embryologic course of the thyroid’s descent from the tuberculum impar of the tongue base to its usual position in the lower neck. Although they may occur at any age, they are most common before age 20. They present as a midline neck mass which is often just below the hyoid bone. Surgical excision is recommended to prevent recurrent infection. This requires removal of the entire fistulous tract along with the middle portion of the hyoid bone through which many of the fistulas pass. Preoperative evaluation should include a thyroid ultrasound to confirm the anatomic position of the thyroid.