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Key Points

  1. To successfully manage patients with branchial cleft anomalies, surgeons must have a thorough understanding of the embryology, anatomy, and clinical presentation of these lesions.

  2. To minimize recurrence and injury to critical structures related to the larynx, surgeons must have in-depth knowledge of normal and pathological neck anatomy in the context of congenital and acquired lesions (ie, thyroglossal duct cysts, dermoid cysts, and other midline lesions).

  3. Torticollis is a common acquired condition related to scarring and atrophy of the sternocleidomastoid muscle and adjacent cervical muscles. Most patients can be treated nonoperatively; however, rarely, patients require surgical intervention to prevent complications such as facial hemihypoplasia and life-long craniofacial asymmetry.

  4. Vascular lesions are the most common benign neoplasms affecting the salivary glands in children. Pleomorphic adenoma is the most common benign epithelial tumor. The high rate of local recurrence of this tumor is problematic.

  5. Malignant neoplasms of the salivary glands (mucoepidermoid carcinomas and acinous cell carcinomas) are uncommon, and most lesions can be managed with surgical excision. High-grade malignancies are extremely rare and tend to occur in younger patients.

  6. Cervical lymphadenitis can be either acute or chronic, caused by a spectrum of etiologies, including viral, bacterial (aerobic, anaerobic, and mycobacterial), fungal, and protozoan infections. Understanding the spectrum and presentation of diseases is essential to selecting appropriate pharmacological and surgical management approaches.


Head and neck lesions in children are extremely common and can be subdivided by etiology into lesions that are congenital and those that are acquired. Most congenital lesions, such as anomalies of the second branchial apparatus and thyroglossal duct cysts, are of embryonic origin. They are usually easily diagnosed on physical examination and seldom require an additional workup. Some of these lesions, however, may not be easily recognized or may not cause clinical problems until adolescence or adulthood. Knowledge of their embryologic origin and their relationship to normal neck structures is essential to successful management. This chapter therefore focuses on the embryology, pathobiology, and surgical management of congenital head and neck lesions. We also present an overview of neonatal torticollis, salivary gland lesions, and acquired lesions caused by neoplasms and inflammatory processes.

Lesions of Embryonic Origin

Anomalies of the Branchial Apparatus

Branchial apparatus anomalies comprise a heterogeneous group of congenital malformations stemming from incomplete in utero resorption of pharyngeal clefts and pouches. Fistulae, cysts, sinus tracts, and cartilaginous remnants are all clinical manifestations arising from these embryonic events. Although all of these lesions are present at birth, many do not become clinically apparent for months or years. In many cases infection is the initial manifestation. Cysts developing from branchial structures usually appear later in childhood than sinuses, fistulae, and cartilaginous remnants, which are observed in infancy. Complete fistulae are more common than external sinuses, and during childhood both are more common than branchial cleft cysts. The incidence of these anomalies ...

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