Objective To study the Diagnosis and treatment of thyroglossal duct cyst or fistula. Methods The clinical data of 67 patients with thyroglossal duct cyst or fistula treated by surgery were analyzed retrospectively. Results The diagnosis rate preoperatively was 92.5% and the accuracy diagnosis rate by B type ultrasonography was 96.1%; all cases were treated by operation, of them, 14 cases underwent simple cyst resection, 12 with resection of partial periosteum of hyoid and 41 with resection of middle segment of hyoid( Sistrunk's operation ). 54 cases were followed up, recurrence in cases with cyst was 4 of 43 (9.3%) and recurrence in cases with fistula was 2 of 11(18.2%)respectively. Conclusion Ultrasonography shows certain characteristics and clinical value to diagnose and distinguish thyroglossal duct cyst. Postoperative recurrence is due to the selection of operation procedures and control of infection of focus. The Sistrunk's operation properly performed previou to cyst infection should reduce recurrence rate markedly.