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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.

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).

Figure 373-1.

Suppurative adenitis/neck abscess in an 8-month-old child.

Figure 373-2.

Firm swelling within the sternomastoid muscle in a 4-week-old child with sternomastoid tumor of infancy (fibromatosis coli).

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 primary treatment for this ...

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