A retrospective review was carried out of 338 patients with thyroglossal duct remnants and 274 patients with branchial cleft anomalies who had undergone surgery at the Mayo Clinic from 1954 to 1975. Attention was directed to the preoperative history of these lesions, their clinical presentation, the nature of surgery performed, the complications of surgery, and the incidence of recurrence. The recurrence rate after the Sistrunk procedure for thyroglossal duct remnants was 2.6 per cent, whereas the recurrence rate after surgery for branchial cleft anomalies was 5.8 per cent. The findings suggested that these lesions are a significant source of morbidity and that surgery should be performed before infection occurs and should be radical in the first instance if the recurrence rate is to be minimized.