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Head and neck masses commonly occur in young children, and the
differential diagnosis for such masses is broad. The initial history
and physical examination usually provides sufficient information
to narrow the possible causes of a swelling in a child’s
head or neck. This should direct the subsequent evaluation and initial
therapy. While the majority of these head and neck masses are inflammatory
in nature, congenital abnormalities and neoplasms can occur and
often require surgical intervention for diagnosis and treatment.
In one review of children with head and neck masses that were biopsied
or excised, 55% had congenital lesions, 27% had
inflammatory masses, and 14% had a benign or malignant
neoplasm.1 A thorough evaluation of a child with
a head and neck mass is necessary to prevent delay in diagnosing
a malignancy and to allow appropriate medical or surgical treatment
of persistent benign diseases.
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Neonates and young infants who present with neck masses at or
close to the time of birth most likely have congenital abnormalities
such as branchial cleft cysts, thyroglossal duct cysts, or vascular
malformations (see Chapter 372). Infants can
also develop infectious neck masses, including abscesses that usually
occur from suppuration of lymph nodes. Neck abscesses in infants
can occur throughout the neck (Fig. 373-1)
and are usually caused by Staphylococcus aureus.2 These
abscesses are treated with appropriate antibiotic therapy (with
the increasing frequency of methicillin-resistant Staphylococcus
aureus in mind) and with surgical drainage when necessary.3 A
neck mass that appears in the first several weeks of life is fibromatosis
coli, also called sternomastoid tumor of infancy, which
presents with a firm lateral neck swelling and is often associated
with a head turn or tilt (Fig. 373-2). Both
parents and primary care physicians often have concerns of potential
malignancy with this presentation. The diagnosis is a clinical one,
supported by ultrasonographic findings of a solid mass within the
sternomastoid muscle, and resolution is expected in almost all infants.4 The
most common malignancies that present as neck masses in infants
are blue-cell tumors, which include neuroblastoma, rhabdomyosarcoma,
and lymphoma (see discussion of malignant neoplasms below).
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Neck masses in preschool children usually are inflammatory in
nature, and transient lymphadenopathy can occur commonly in association
with other infectious symptoms. Congenital neck masses may first
present at this age, when a quiescent congenital cyst enlarges as
a result of infection. Nontuberculous mycobacterial adenitis occurs
primarily in this age group, usually presenting as a mass in the
submandibular, parotid, or upper neck areas that eventually causes
skin discoloration or fistula formation.5 Surgery
is the ...