Congenital thyroglossal cysts and fistulas, also known as anterior median cervical cysts and fistulas, arise when the thyroglossal ducts do not degenerate or do not completely degenerate and disappear during thyrogenesis. They can occur anywhere between the blind foramen of the tongue and the superior sternal notch. The internal fistula of the thyroglossal fistula is located in the lingual blind foramen and the external fistula is on or slightly to the side of the anterior midline of the neck. When the cyst is located below the hyoid bone, the fistula connecting the cyst to the blind foramen of the tongue may travel anteriorly, intra- or posteriorly through the hyoid bone. Differentiate from gill slit cysts, dermatomal cysts and ectopic thyroid glands. 1. Most commonly seen in pediatric patients and young adults. There is a round mass under the plane of the anterior hyoid bone of the neck, with smooth surface, clear boundary, cystic feeling and no skin adhesion, moving up and down with swallowing. It can be palpated along the hyoid bone, and the mass can be retracted and lifted up when the mouth is opened and the tongue is stretched. 2, cyst secondary infection, local redness, swelling, tenderness, self-rupture or incision and drainage, can form a long-lasting fistula. 3, mucus secretion, often containing columnar and squamous epithelial cells. Clinical manifestations 1, thyroglossal cyst: smaller cysts located above the hyoid bone can be asymptomatic, and only when the cyst increases in size, there is swelling in the tongue, foreign body sensation in the pharynx, dysphonia, and a circular bulge at the root of the tongue is seen on examination. Cysts located below the hyoid bone and before the thyroid hyoid membrane are more common. Patients often have no obvious symptoms, and examination reveals a semicircular bulge under the skin in front of the neck, with smooth and elastic surface and no adhesion to the skin, which can move up and down with swallowing. The cyst can be punctured to extract translucent or cloudy, thick and thin fluid. 2, thyroglossal fistula: the external fistula is often located on the anterior midline of the neck between the subchin and the thyroid cartilage or slightly to the side of the treatment principles 1, early surgery is advisable after diagnosis. All cysts and fistulas should be removed and part of the hyoid bone at the attachment of the cyst should be removed to avoid recurrence after surgery. 2.For acute infection, incision and drainage and anti-infection treatment should be performed first, and then surgical excision should be performed after the inflammation subsides. The thyroglossal cyst cannot be treated with drugs, but only with surgery. And the surgery is not complete there is a possibility of recurrence.