Neck Mass in Children

Neck masses in children commonly originated from congenital lesion, inflammatory or reactive mass and neoplastic growth. The commonest congenital midline neck mass would be thyroglossal duct cysts and other congenital neck mass would includes dermoid cysts, branchial cleft cyst or sinus, lymphatic malformation, vascular malformation and hemangioma.

Bilateral Branchial Cleft sinus discharging chronically through a small opening at both lower part of the neck

Another common neck masses in children would be cervical lymph node enlargement due to reaction to infection or inflammation. Viral infection, staphylococcal, cat scratch disease and mycobacterium tuberculosis need to be ruled out. In Malaysia, tuberculous lymphadenitis is common especially with the influx of foreign workers.

Neoplastic in children might be due to neurofibroma, fibroma, salivary gland tumours and rarely malignant lesion such as lymphoma, rhadomyosarcoma, thyroid carcinoma and metastasis nasopharyngeal carcinoma.

Investigation which includes blood tests, mantoux test and chest radiography if suspicious of tuberculosis. Fine needle aspiration might be needed if the initial medical treatment failed.

Ultrasonography is preferred for developmental mass and computed tomography with contrast media is reserved for malignancy or suspected deep neck abscess. Excisional or incisional biopsy might be required to establish the diagnosis especially when the initial investigation failed to ascertain the origin of the mass or in cases where there is high suspicion of lymphoma. Excisional or incisional biopsy usually should be done only after the investigation of tuberculosis have failed to yield any result and solid malignancy have been rule out via FNAC.

The main problem in cervical mass in children is to establish the diagnosis, treatment is tailored to the correct diagnosis. Medical treatment is advocated if the diagnosis is reactive or inflammatory.  Surgery would be an option for a few reasons which include to establish the diagnosis, as treatment especially in benign neoplastic, congenital mass and in certain malignant lesion.