Midline cysts of the neck are the most common congenital malformations of the neck. They arise along the thyroglossal duct. The presence of a fistula is the result of either spontaneous (suppuration) or surgical fistulisation (simple incision or incomplete excision). The cyst and/or fistula are located between the base of the tongue and the thyroid gland, predominantly adjacent to the hyoid bone. This midline site can be explained by embryological development of the thyroid gland. Treatment is surgical. Many techniques have been described, but Sistrunck procedure (described in 1920), based on embryological studies, remains the reference technique with a recurrence rate of less than 3%, provided surgery is performed correctly, comprising resection of the body of the hyoid. Risk factors for recurrence are: surgery during the inflammatory phase, cyst rupture during dissection, multiple thyroglossal ducts and a technical error during the surgical procedure.