Head and Neck Masses
Drs. Christopher Hartnick and Leila Mankarious from the Pediatric Otolaryngology Service care for children with a wide variety of head and neck masses. These include inflammatory lesions, congenital masses, and both benign and malignant neoplasms. Knowledge of these conditions and their clinical presentations is essential to their proper diagnosis and management.
The vast majority of head and neck masses in children are benign lesions of inflammatory origin that either resolve spontaneously or respond to appropriate medical therapy. Operative biopsy or drainage for diagnostic or therapeutic purposes becomes necessary in the treatment of persistent or recurrent inflammatory masses. Persistent lymphadenitis, for example, can be due to such disorders as nontuberculous (atypical) mycobacteria, cat scratch disease or Kawasaki disease. Lymphadenitis and cellulitis can also progress to abscess formation. Such deep neck infections most commonly involve the retropharyngeal, parapharyngeal (lateral pharyngeal) and submandibular-submental spaces.
Congenital anomalies are likely to be present at birth but some remain unnoticed until later in life when secondary infection causes acute enlargement. Congenital lesions may also initially manifest as an asymptomatic sinus or fistula opening. The anatomic location of the neck mass or sinus/fistula opening may suggest its origin. A midline neck mass, for example, raises suspicion of a thyroid anomaly or a cervical dermoid. The most common lesions of the lateral anterior neck are of branchial origin, although both dermoid cysts and thymic gland anomalies can occur in this region. Congenital lesions of the posterior lateral neck are uncommon with the exception of hemangioma and vascular malformations. These lesions can involve contiguous neck regions. (see Hemangiomas and Vascular Malformations for additional information.)
Primary Malignant Tumors
Although comparatively rare, an estimated 5% to 10% of primary malignant tumors in children originate in the head and neck, and one of every four other malignant lesions has eventual manifestations in the head and neck region. A noninflammatory, firm neck mass in a child is considered of potential neoplastic etiology until proven otherwise.
Factors increasing the risk that a solid neck mass may be malignant include onset in the neonatal period, a history of rapid or progressive growth, skin ulceration, fixation to underlying structures, or a firm mass greater than 3 cm in diameter.
Benign cervicofacial neoplasms include pilomatrixomas, lipomas, peripheral nervous system tumors, nasopharyngeal angiofibroma and the sternomastoid tumor of infancy. Malignant lesions often involving the head and neck region include Hodgkin's and non-Hodgkin's lymphoma, rhabdomyosarcoma and other soft tissue sarcomas, a variety of salivary gland malignancies, neuroblastoma and nasopharyngeal carcinoma.