Otolaryngology Book

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Neck Masses in ChildrenAka: Neck Mass in the Child

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  1. See Also
    1. Lymphadenopathy of the Head and Neck
  2. Epidemiology
    1. Neck masses in children are benign in 90% cases
  3. Etiologies: Congenital Neck Mass (55%)
    1. Thyroglossal Duct Cyst
    2. Dermoid cyst
    3. Sebaceous Cyst
    4. Branchial Cleft Cyst
    5. Lymphangioma or Cystic Hygroma
    6. Hemangioma
    7. Teratoma
    8. Thymic Cyst
    9. Bronchogenic Cyst
    10. Laryngocele
  4. Etiologies: Inflammatory Neck Mass (27%)
    1. Reactive Lymphadenopathy
      1. Present in 40% infants
      2. Present in 55% all healthy children
      3. Cervical node size <3 mm is normal
      4. Cervical node size <=1 cm normal under age 12 years
    2. Bacterial
      1. Causes
        1. Staphylococcus aureus
        2. Beta hemolytic Streptococcus
        3. Viral Lymphadenitis
      2. Nodes Tender and fluctuant
      3. Unilateral tender and fluctuant adenopathy
    3. Granulomatous Disease
      1. Mycobacterium Avium Intracellulare (MAI)
      2. Cat Scratch Disease
      3. Toxoplasmosis
      4. Sarcoidosis
      5. Histoplasmosis
      6. Actinomycosis
      7. Fungal Infection
    4. Other infectious causes
      1. AIDS
      2. Kawasaki's Disease
      3. Sialadenitis
  5. Etiologies: Neoplastic Neck Mass (11%)
    1. Malignant
      1. Hodgkin's Disease Lymphoma
      2. Non-Hodgkin's Lymphoma
      3. Thyroid Cancer
      4. Rhabdomyosarcoma
      5. Neuroblastoma
      6. Fibrosarcoma
    2. Benign
      1. Lipoma
      2. Fibroma/Neurofibroma
      3. Lipoblastoma
      4. Paraganglioma
      5. Goiter
      6. Salivary Gland Tumor
  6. Etiologies by Location: Anterior Triangle
    1. Submandibular
      1. Lymphadenitis
      2. Cystic Hygroma
      3. Sialadenitis
      4. Atypical Mycobacterial Infection
      5. Cat-Scratch Disease
    2. Carotid
      1. Lymphadenitis
      2. Branchial Cleft Cyst
      3. Cystic Hygroma
    3. Submental
      1. Lymphadenitis
      2. Thyroglossal Duct Cyst
      3. Dermoid cyst
      4. Cystic Hygroma
    4. Midline
      1. Thyroglossal Duct Cyst
      2. Dermoid cyst
      3. Lymphadenitis
    5. Anterior Sternocleidomastoid
      1. Lymphadenitis
      2. Branchial Cleft Cyst
  7. Etiologies by Location: Pre-auricular
    1. Lymphadenitis
    2. Cystic Hygroma
    3. Parotitis
    4. Atypical Mycobacterial Infection
    5. Cat Scratch Disease
  8. Etiologies by Location: Posterior Triangle
    1. Occipital
      1. Lymphadenitis
      2. Lymphoma
      3. Metastatic Disease
      4. Cystic Hygroma
    2. Supraclavicular
      1. Lymphoma
      2. Cystic Hygroma
      3. Metastatic Disease
      4. Mediastinal disease
        1. Tuberculosis
        2. Histoplasmosis
        3. Sarcoidosis
  9. Criteria for Cervical Node Biopsy
    1. Palpable node present in newborn
    2. Node has increased in size after two weeks
    3. Node has not decreased in size after 4-6 weeks
    4. Node has not regressed to normal size within 8-12 weeks
    5. Signs of serious disease indicate early biopsy
      1. Progressively enlarging firm-hard node >2 cm diameter
      2. Supraclavicular adenopathy (no pulmonary infection)
      3. Persistent fever or weight loss
      4. Fixation of node to adjacent tissue
      5. Node in atypical site
        1. Posterior triangle
        2. Deep to Sternocleidomastoid
  10. References
    1. Townsend (2001) Sabiston Surgery p. 1498-500

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