Cysts and fistulas derived from thyroglossal tract remnants are often encountered in childhood. The major difficulty in management has been recurrence after inadequate excision. Starting at the foramen cecum, the thyroglossal tract passes down in the midline ; first, through the tongue musculature and then, anterior to the hyoid bone and larynx, before ending at the thyroid isthmus on the trachea. Remnants may occur at any point along this pathway, and are frequently multiple so that simple excision of a cyst is often followed by recurrence. Twenty-three cases of thyroglossal duct anomaly who had been admitted to the Department of Otolaryngology, Seoul National University Hospital from January 1982 to December 1986 were analyzed clinically. The results were as follows : 1) Among 23 cases, there were 10 males(43.5%) and 13 females(56.5%), and there was no statistical significance in sex distribution. By age distribution, 5 cases(21.3%) were under the age of 10, and 12 cases(51.8%) were in their first 2 decades. 2) Twelve cases(52%) were under the age of 10 at the time of onset. 3) As for the interval between the onset and the operation, 9 cases(39%) were operated within 1 year. 4) Eight cases(35%) yielded the history of the previous operation for the thyroglossal duct anomaly for at least once. 5) There were 19 cases(83%) with the cyst, and 4 cases(17%) with the fistula. 6) As for the position of the lesion, 18 lesions(70%) were in the midline, 3 lesions(10%) left to the midline, and 5 lesions(20%) right to the midline. All of the lateralized lesions were within 2cm from the midsagittal plane. 7) As for the size of the cyst. 15 cysts(65%) were smaller than 2cm in diameter, 7 cysts(35%) were 2-4cm, and the largest one was 3.5×4×4cm in dimension. 8) Four lesions(15%) were above the hyoid bone and 22 lesions(85%) were below the hyoid bone. 9) As for the extent of the thyroglossal tract, the tracts that extended to the hyoid bone were found in 8 cases(34.8%), the tracts that extended all the way to the foramen cecum were seen in 13 cases(56.5%), and there were no tracts in 2 cases(8.7%). 10) As for the relation to the thyroid gland, the tract was connected to the pyramidal lobe inferiorly in 1 case. 11) In all cases, Sistrunk operation was performed and there was neither complication nor recurrence after a year of follow-up.