Introduction: Thyroglossal duct cyst (TGDC) and/or fistula represent the most common congenital anomaly of the neck. A wide range of procedures were described for managing thyroglossal cysts. These procedures are varying from simple cyst excision up to anterior block neck dissection. Objectives: to evaluate the concept of posterior hyoid space according to Maddalozzo modification of Sistrunk operation. Patients and methods: This prospective study was conducted at general surgery departments of Benha and Zagazig University Hospitals. Twenty-eight patients diagnosed to have primary TGDC were included in this study. The surgical technique as described by Maddalozzo et al. Results: Twenty patients (71 %) were complaining of anterior neck cystic swelling and eight patients (29 %) were with neck fistula. After histopathological examination; the tract passed in front of the hyoid bone in all cases (100 %) while ectopic thyroid follicles were detected ventral to hyoid bone in 11 cases (39%), behind the hyoid bone in three cases (11%) and in four cases (14%), found in both ventral and dorsal position Conclusion: Our results were encouraging, and this approach of PHS deserves a wider spread for more assessment of its efficacy and benefits. And also, to evaluate the possible rule of ectopic thyroid tissues in recurrence with classic Sistrunk procedure.