Abstract Of 69 cases of midline cervical swelling in children, the correct diagnosis was made in only 38 (55 per cent). Fifty cases of thyroglossal cyst or abscess were treated and 38 per cent suffered recurrence. Apart from failures in diagnosis, the main reasons for preventable recurrence were delay in surgery, failure to resect part of the body of the hyoid bone and a tendency to excise that portion of the duct above the level of the hyoid with insufficient surrounding muscle. In cases without florid abscess formation, the aim should be to perform a radical operation as soon as possible, then cure can be guaranteed at the first operation. Recurrence may occur many years after an apparent cure. Cysts in the submental region are not often recognized as being of thyroglossal duct origin.