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The
appearance of a new "lump," or mass, on your child's body can
be a source of great concern to parents. While we always
recommend that you have these evaluated by your doctor, and while
many masses will require surgical excision for a definite diagnosis,
most often little "lumps" represent benign processes.
The head and
neck are areas where new masses frequently appear. Some
of the more common benign causes of these are:
...and others.
Abscesses
in the neck frequently start as bacterial infections of the lymph
nodes. Parents may notice that the skin overlying a little
neck mass is red and warm, and the child may be tender in the
area. Younger children often have a fever as well.
Oral antibiotic therapy can be very effective in treating lymph
node infection (or lymphadenitis), so much so that an abscess
doesn't have a chance to form. In other cases, even with
early and appropriate antibiotics the infection progresses; the
lymph node will increase in size, the skin overlying it will become
tight and shiny, and an abscess will begin to form.
Deciding when
an abscess is ready for surgical drainage is based on clinical
examination. Ultrasound of the affected area may be helpful
if the physical exam is difficult or equivocal; if the ultrasonographer
sees fluid in the center of the infected mass, the abscess is
generally mature enough to drain. Surgical drainage may
be performed in the operating room or in the office setting, depending
on the size and position of the abscess and on the age of the
child. Children usually improve rapidly after these procedures,
with temperatures coming down to normal in a day or two and much
less discomfort.
Branchial
cleft derivatives
Branchial
cleft cysts, sinuses, and fistulas are remnants of the embryonic
processes that form the structures of the head and neck.
They may be apparent at birth, or may not be visible until later
in childhood when they fill with secretions. The most common
are termed "second branchial cleft" anomalies, and are seen along
the anterior border of the sternocleidomastoid (the neck muscle
that passes from the mastoid process--the bone just behind the
ear-- to the clavicle, or collarbone). These anomalies should
be excised when they are diagnosed, since they may become infected
(and excision after an infection has occurred is more difficult).
Dermoid
cysts are superficial, congenital lesions that are also termed
"inclusion" cysts; they often contain skin elements, and fill
with secretions from these elements. They are benign, but
may become infected or rupture, so it is recommended that these
be excised when they are diagnosed. Dermoid cysts may be
found in a number of locations over the head and neck. Common
sites include the anterior neck, the forehead, and the scalp.
The
most common causes of neck masses in children are lymph nodes
(or "benign cervical lymphadenopathy"). One of the functions
of the lymph nodes is to act as a filter for the lymphatic fluid
that drains into them from the body's tissues. For example,
if a child has a viral or bacterial infection of the ear or throat,
the infected tissue fluid may filter through a lymph node; the
lymph node helps to contain the infection, but may also enlarge
in response to it.
Solitary
enlarged lymph nodes that are smaller than about half an inch,
are mobile (move freely), and show no signs of forming an abscess
may generally be treated conservatively. Most of these will
resolve on their own. However, if a mass thought to be an
enlarged lymph node does not meet these criteria, we will often
recommend a biopsy (or excisional biopsy).
Thyroglossal
duct cysts form as a result of embryonic development of the thyroid
gland. They originate beneath the tongue, in the pharynx, and
pass down through the anterior part of the neck toward the thyroid
gland. The cysts are generally found in the midline anteriorly,
over the hyoid bone. They may change in size over time,
sometimes growing larger and then smaller. However, they
do not disappear spontaneously.
Since
these lesions can become infected, and because they are much more
difficult to remove once they have been infected, we generally
recommend surgical excision when the diagnosis is made.
This operation, like the others discussed on this page, is often
done as a "same-day surgery."
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