Neck Mass Conditions

• Enlarged Lymph Node
• Atypical Tuberculosis (TB) Infection
• Branchial Cleft Cyst
• Thyroglossal Duct Cyst
• Dermoid Cyst
• Fibromatosis Coli
• Lymphatic Malformation
• Hemangioma
• Thyroid Gland Mass

 

A neck mass is any sort of swelling or mass that occurs in the neck or face. Neck masses can occur at any age and may be caused by a number of different conditions. The general categories of neck masses are congenital lesions, infectious lesions, and tumors; both benign and cancerous. The following are a list of common neck masses that are encountered in children and adolescents.

Enlarged Lymph Node

Lymph nodes are round or bean shaped organs that are all of the body. The lymph nodes are part out the immune system. There are several dozen lymph nodes that are present in the head, neck and face that are normally small and cannot be felt.  The lymph nodes of the neck and face drain and filter fluid to help fight infections and other diseases. Your child’s lymph node(s) may swell from infections such as an upper respiratory infection or strep throat. On rare occasions the swelling may be from a cancer within the lymph node.  The lymph node swelling is a normal reaction to an infection. The swelling may be abnormal if it does not come back to normal size or the lymph node itself becomes infected. Often swollen lymph node(s) may not have any symptoms, but children may exhibit one or more of the following symptoms:

• Redness or warmth over the area of the lymph nodes
• Pain when touching the lymph nodes
• Fever
• Pain or stiffness moving the head

If swollen lymph nodes do not return to normal or do not respond to antibiotics, your child’s primary doctor may refer you to a pediatric ENT specialist for further evaluation. The evaluation of swollen lymph nodes includes a thorough history and exam to determine a possible cause. Based on the possible causes for the persistent swollen lymph node, your ENT for Children surgeon may recommend further antibiotics, imaging tests or even a biopsy or removal of the lymph node. We may also discuss observation if the lymph node is not worrisome and not causing any problems.

Atypical Tuberculosis (TB) Infection

An unusual type of infection in the neck is an atypical tuberculosis infection. This particular infection is from a slow growing bacteria called mycobacterium. This bacterium is different but in the same family as the tuberculosis bacteria that causes serious lung infections. Atypical TB infections tend to occur in healthy, young children that acquire the infection from contaminated soil, water or vegetation. The most common site of atypical TB infections is the lymph nodes underneath the jaw. These infections often do not respond to typical antibiotics that are given for common head and neck infections.

Symptoms of an inflamed neck mass caused by atypical TB usually include a slowly enlarging neck mass that moves closer to the skin surface. The skin may then become red and inflamed but usually does not cause much pain. The infection may come to a head and open up and start draining. Diagnosis of an atypical TB infection often is from the history and examination. Cultures of the drainage can confirm the infection.

Treatment of this infection includes special antibiotics that target the bacteria. Since the infection is slow growing, the antibiotics may need to be given for several weeks. Your ENT for Children surgeon may also discuss surgery to either partially or fully remove the infected lymph node. This can often treat the infection faster, get a confirmation of the infection and shorten the duration that antibiotics are needed.

Branchial Cleft Cyst

A branchial cleft cyst is a congenital lesion that a person or child is born with. The cyst can become noticeable at any time and usually occurs in the side of the neck but can also occur in front of the ear. Most branchial cleft cysts occur in children but some are not discovered until adulthood. The cyst can fill up with fluid and develop into a noticeable, painless swelling in the neck or face. Occasionally the cyst will have a tract and the fluid can drain out of a small opening in your child’s neck.

The branchial cleft cyst develops from a defect that occurs in your child’s early embryonic development when the tissues in the neck do not form properly.

Symptoms of a branchial cleft cyst vary. Some children will have a painless swelling in the side of the neck or face, others will have small opening in the neck that drains fluid. If the cyst fluid becomes infected, then the mass can become very painful, red and swollen.

The treatment of a branchial cleft cyst is surgical removal. Once a cyst fills up with fluid or drains, it will continue to do so and it always poses a risk for infection. Complete removal of the cyst and/or draining tract will permanently cure the problem.

Thyroglossal Duct Cyst

A thyroglossal duct cyst is another congenital disorder in the neck and occurs during embryonic development after a baby’s thyroid gland has formed. A baby’s thyroid gland forms at the end of a stalk that is known as the thyroglossal duct. This duct starts at the back of the tongue and extends down the center of the neck to where the thyroid gland sits. Once the thyroid gland forms, the duct should disappear. If a portion of the duct remains then it can develop into a cyst called a thyroglossal duct cyst. The cyst can fill up with fluid or mucous which can later become infected.

A thyroglossal duct cyst usually becomes noticeable during childhood when if fills up with fluid and becomes a mass. The cyst is usually in the midline of the neck and can occur under the chin or down by the Adam’s apple. Many thyroglossal duct cysts do not cause any symptoms, but if the cyst becomes large or infected then the following symptoms may occur:

• Tenderness and redness around the area
• Trouble swallowing

Once a thyroglossal duct cyst has been diagnosed, the treatment is surgical removal. Complete removal, which includes the cyst and the duct, will treat the mass and ensure that it does not return.

Dermoid Cyst

A dermoid cyst is another type of congenital cyst that forms in the middle of the neck. This type of cyst occurs when skin cells become trapped in the deeper tissues during embryologic development. These skin cells then grow and develop into a benign cyst. A dermoid cyst may be diagnosed by history and examination or by obtaining an imaging test such as an ultrasound.  The diagnosis is confirmed when the cyst is removed at the time of surgery.

The dermoid cyst might appear in the mid-line of your child’s neck in the form of a lump or mass. While the cysts are benign and typically not painful, they can become infected. Your ENT for Children specialist may recommend surgery to remove the dermoid cyst to keep it from enlarging and to prevent infections.

Fibromatosis Coli

Fibromatosis Coli, also known as Psudeotumor of Infancy, occurs due to an overgrowth of cells in the neck of an infant or newborn. The condition occurs in the sternocleidomastoid muscle in the neck and is not a true tumor.  The mass is from a fibrosis and swelling within the muscle on one side of the neck. The cause of this disorder is not entirely known, but babies born via a difficult or breach delivery are more likely to have this disorder.

Symptoms of Fibromatosis Coli include an appearance of a mass in the side of an infant’s neck where the sternocleidomastoid muscle is located. The mass does not become infected and does not cause pain. However, since the mass is actually fibrous tissue, it can impair a child’s ability to rotate the neck. This may lead to torticollis (constant turned appearance of the head) or plagiocephaly (flattening of the back of the head).

Your pediatric ENT specialist may recommend an ultrasound to diagnosis the condition. If the diagnosis of fibromatosis coli is made, your ENT for Children specialist will discuss the condition with you in more detail.  Luckily, most cases of fibromatosis coli will resolve on its own. If the condition does not resolve or starts to cause torticollis or plagiocephaly, then physical therapy may be required. On rare occasions, surgery is performed to release the fibrous tissue so that the head can turn freely again.

Lymphatic Malformation

A lymphatic malformation (LM) is a congenital lesion that may develop anywhere in the head and neck. This lesion develops during embryonic development prior to birth. The lesion is an abnormal collection of lymph vessels that fill up with normal body fluid. The lesion may be enlarged and noticeable at birth or can develop later in childhood.

A lymphatic malformation may occur in the form of one of the following types:

• Macrocystic – This type describes the lymph channels as large and dilated with only a few walls between the channels.

• Microcystic – This type describes the lymph channels as very small and numerous with countless walls between the channels.

A lymphatic malformation can present as a painless, soft swelling in the mouth, tongue, cheek, face, or neck. The mass can progressively enlarge and cause problems such as abnormal appearance or difficulty eating or breathing if the mass is present near the tongue or throat. The fluid within the mass can become infected resulting in swelling, warmth and pain.

Your ENT for Children specialist may suspect a lymphatic malformation based on the history and physical exam.  The diagnosis can be confirmed with an MRI imaging test or a needle aspiration of the fluid. Once the diagnosis and type of lymphatic malformation is known, your pediatric ENT will discuss different treatment options. This may include surgery to remove the mass or sclerotherapy, which is a specialized radiology procedure to scar closed the inside of the lymph vessels, or a combination of both.

Hemangioma

A hemangioma is a congenital skin lesion or birthmark that may appear near the skin surface.  A hemangioma is classified as a benign tumor and can occur anywhere in the body, especially near the head and neck. Hemangiomas may not be present right at birth but may develop a few weeks later and continue to enlarge. A typical hemangioma goes through predictable life cycle.  The first phase is rapid growth that can occur for months. After this phase the hemangioma will slowly involute (reduce in size) over several years. The last phase is the residual scar that is left behind.

Although most hemangiomas are cared for by a dermatologist or plastic surgeon (due to the cosmetic appearance), a pediatric ENT physician may get involved in your child’s hemangioma care if the lesion is affecting important functions of the head and neck such as swallowing, breathing or the voice.

Thyroid Gland Mass

The thyroid gland is an important gland in the body that produces thyroid hormone, which is essential to many of our body’s functions. Within the thyroid gland, there can be masses or cysts that develop. These can occur at any age but are most common in adolescents and adults. A mass within the thyroid gland can occur as nodules, cysts or tumors (both benign and cancerous). Most thyroid masses can be assessed with radiologic tests such as ultrasounds, CT scans or MRIs. These are briefly discussed below:

• Thyroid Nodule: A thyroid nodule is the most common mass that can develop within the gland. It is benign and usually does not cause any problems. The thyroid function usually stays normal. In unusual cases multiple nodules can develop, which is also known as a multinodular goiter. Often thyroid nodules can be observed closely and may not need surgery. It is important to follow nodules closely to make sure that they do not develop into a cancer.

• Thyroid cyst – A thyroid cyst is a fluid filled mass within the gland. The cyst is filled with fluid or blood. Cysts are usually benign and do not need surgery unless they become very large or cause other symptoms such as pain or trouble swallowing.

• Thyroid Tumors – Tumors can develop within the thyroid gland at any age including children and adolescents. These tumors can be benign or cancerous. Most tumors present as a lump in the neck and do not cause any pain or problems. If a solid mass is found within the thyroid gland, it should be evaluated for possible cancer. This may include imaging tests and/or needle biopsies. If there is concern for thyroid cancer, your pediatric ENT surgeon may discuss surgery to remove the mass. Often a pediatric endocrinologist is also consulted to help with hormone balance and possible additional treatments for thyroid cancer.