Ten children were admitted with recurrences of thyroglossal duct remnants (TDRs) during the years 1978-1993. Unexcised infrahyoid extension of the thyroglossal duct was found to be the cause of recurrence in 3 cases, whereas the remainder were due to misdiagnosis and inappropriate surgery. After surgical treatment, these three cases were evaluated regarding the cause of recurrence. The treatment of choice for these lesions is the Sistrunk procedure. The complete Sistrunk procedure solves the problem in the majority of patients, but in cases with infrahyoid extension tracing of the extension is required. It is concluded that an appropriately performed Sistrunk procedure assures a complete cure in the vast majority of cases of TDRs; however, routine exploration for and excision of the occasional infrahyoid extensions is recommended for the prevention of recurrence.