Head and Neck Masses
The majority of head and neck masses in children are benign lesions caused by inflammation that either resolve spontaneously or respond to appropriate medical therapy, such as bacterial and viral infections producing infections of the lymph nodes of the neck.
If a mass is persistent or reoccurs, operative biopsy or drainage may become necessary. For some patients with persistent or reoccurring masses, they might have an underlying condition such as nontuberculous (atypical) mycobacteria, cat scratch disease, or Kawasaki disease, which we will also help identify if present. Sometimes a mass might also progress due to abscess formation. In these cases, we would consider either a needle biopsy, an incisional biopsy (removing a small piece), or an excisional biopsy (removing the mass completely).
Some of the most common masses seen include:
Congenital anomalies are likely to be present at birth, but some remain unnoticed until later in life when secondary infection causes sudden enlargement. Congenital lesions may also initially manifest as an asymptomatic sinus or fistula opening. The location of the neck mass or sinus/fistula opening may suggest its origin. A midline neck mass, for example, raises suspicion of a thyroid abnormality or a cervical cyst.
Primary Malignant Tumors
Although comparatively rare, an estimated 5 to 10 percent of primary malignant tumors in children originate in the head and neck, and one of every four other malignant lesions spread to the head and neck region.
A non-inflammatory, firm neck mass in a child is considered of potential tumor 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.
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