Congenital thyroglossal cysts and fistulas, also known as anterior median cervical cysts and fistulas, arise when the thyroglossal ducts have not degenerated or have not completely degenerated and disappeared during thyroidogenesis. It can occur anywhere between the blind aperture of the tongue and the suprasternal notch. Thyroglossal fistulas have an internal fistula located in the glabellar foramen and an external fistula in the anterior midline of the neck or slightly to the side. When the cyst is located below the hyoid bone, the fistula connecting the cyst to the foramen magnum may travel anteriorly, internally, or posteriorly through the hyoid bone, with the posterior hyoid bone being the most common route. Diagnosis: X-ray iodine-oil contrast of the fistula or cyst helps to clarify the diagnosis. However, it should be differentiated from gill slit cysts, dermoid cysts and ectopic thyroid. 1, Most common in pediatrics and young adults. There is a round mass under the plane of the hyoid bone in the front of the neck, with smooth surface, clear boundaries, cystic sensation, no adhesion of the skin, moving up and down with swallowing. Along the direction of the hyoid bone can be touched with a cord, and the mass can be retracted and lifted up when the mouth is opened and the tongue is stretched out. 2, cyst secondary infection, local redness, swelling and tenderness, self-rupture or cut and drain, can form a long-lasting fistula. 3, mucous secretion, often containing columnar and squamous epithelial cells. Therapeutic measures: non-surgical treatments such as cauterizing the fistula with corrosive agents are ineffective, and it is generally advocated that the fistula should be completely removed by surgery. Its surgical methods: 1, the patient lying on his back, pillow under the shoulder, head tilted back. 2, incision: in the most elevated cyst, make a transverse incision along the dermal lines, if there is a fistula, make a transverse pike-shaped incision around the fistula, and separate the upper and lower dermatomes. 3, exposure of the cyst and separation of the fistula: longitudinal separation of the sternocleidomastoid muscle, exposing the cyst envelope. In order to determine the stroke and depth of the fistula, the fistula or cyst is injected with methylene blue, and the skin opening of the cyst or fistula is grasped with tissue forceps and separated in the direction of the hyoid bone, and care should be taken not to injure the superior laryngeal nerve and blood vessels during the operation. 4, resection of the middle of the hyoid bone: separation to the hyoid bone body, carefully check whether the blind end of the pipe stops here, if it stops here, then the fistula and the cyst will be resected together. If the tube rises around the hyoid bone, it should be cut off at 0.7-1cm on each side of the midline of the hyoid bone, and the hyoid bone of 1.5-2cm length should be removed. The hyoid bone and tongue muscle are cut along the midline, and the fistula is separated from the deeper part of the tongue to the root of the tongue. At this time, the index finger extends into the mouth to push the tongue root blind hole to the anterior down, in the surgical field behind a protruding point can be seen, this time the end of the fistula, the fistula will be cut off, with intestinal sutures at the tongue blind hole defect. 5, layer by layer suture incision, and put rubber drainage strip. Postoperatively, attention should be paid to clean the mouth and control the infection with antibiotics or sulfonamides. Surgical treatment is performed to remove the cyst, fistula, and the middle part of the hyoid bone right up to the lingual blind foramen. To facilitate intraoperative search may be injected with methylene blue staining. In combination with acute infection, the infection should be controlled with antibiotics or incision and drainage first, and then surgically removed three months after the analogous condition subsides.