Pediatric Neck Masses Types and Causes, Symptoms, Diagnosis and Treatment

Pediatric neck mass is a lump or swelling which are common in children. The cancerous neck masses are present but are rare. Some of the neck masses are present from the birth because of the abnormal developmental process in the pregnancy. Some neck masses are incidious in the onset and might be painful. Some masses are chronic in onset and are generally less painful. Most of the neck masses are incidentally found when the clinician is examining the patient for a normal cough and cold.

Pediatric Neck Masses Types And Causes

1. Thyroglossal duct cyst : 
   • It is a midline mass and is a second most common neck mass. 
   • It is a tract formed between foramen cecum and base of anterior neck which is a path of thyroid descent.
   • The main finding of this mass is that it is cystic and moves with swallowing or tongue protrusion.
   • Most of the time an upper respiratory tract infection will be present along with it.
   • It is generally associated with an ectopic thyroid tissue.
2. Dermoid cyst
   • It is a cystic midline mass which contains trapped epithelial debris.
   • There is no displacement with tongue protrusion.
   • It occurs along an embryonic fusion planes.
3. Branchial duct cyst
   • It is a lateral mass which is present anterior to the sternocleidomastoid muscle.
   • It is formed due to the tract that may extend to the tonsillar fossa ( 2^nd branchial branch) or pyriform recess.
   • It is painless and firm mass.
4. Cystic hygroma
   • It is the posterior mass which is formed due to failure of one of the lymphatics to join the major lymph sac of the body. 
   • It is a sac like mass which mainly consists of dilated lymphatci vessels.
   • Associated with the turner’s syndrome.
5. Reactive adenopathy
   • It is a lateral mass which is firm and often tender.
   • It contains multiple nodules.
6. Torticollis
   • It can be congenital or acquired.
   • The nose/face rotates to the left and right ear tilts toward the right shoulder. There will be tight right Sternocleidomastoid muscle.

Pediatric Neck Mass Symptoms

• In cystic hygroma there will be breathing difficulties due to airway obstruction. The child will also find feeding difficulties. 
• In Thyroglossal duct cyst, there will be difficulty in swallowing or breathing. If get infected there will be tenderness, redness and swelling of the mass.
• Branchial cleft cysts grow bigger with time and these can get painful and more swollen . Concomitant upper respiratory infection can occur. The fluid exiting the neck from the skin opening can be seen. Pain, dysphagia and dyspnea can be seen.

Pediatric Neck Mass Diagnosis

• Most of the neck masses are easily visible or are palpable. So most of the pediatric neck masses are diagnosed when parents bring their children to the clinicians for random checkup.
• In Thyroglossal duct cyst, Ultrasound should be done to make sure if any ectopic thyroid tissue avilable or not. TSH screening can performed also. 
• Branchial cyst can be diagnosed with Ultrasound, CT scan or MRI. Sometimes hearing examination is also required if the branchial cyst is from 1^st cleft.
• Dermoid cyst are diagnosed as a soft, painless mass and confirmed using the MRI, Ultrasound and CT scan.
• Toritcollis presents with clinical features of reduced neck range of motion , palpable SCM mass and abnormal head position. However some cases required MRI and imaging.

Pediatric Neck Mass Treatment

• Thyroglossal cystic duct  is surgically resected . There is surgical resection of cyst, the associated tract and the central portion of the hyoid bone.
• Branchial duct cyst is surgically excised. If get infected the incision and drainage should be done followed by resection after resolution of the infection.
• Dermoid cyst is also treated with the surgical removal of the cyst. If the cyst enters the bone then it maybe need to scrap the bone also.
• There is no standardized treatment for SCM torticollis but infants usually improve by one year of age.

Hope you found this blog helpful for your ENT residency head and neck preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.

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