Neck Masses (Cysts and Sinuses of the Head and Neck)

The majority of neck masses in children are benign enlarged lymph nodes caused by infection or inflammation. Neck masses are rarely cancerous. Some neck masses are inherited.

What are the types of neck masses in children?

Lymphadenopathy/Lymphadenitis

Enlarged lymph nodes, also known as lymphadenopathy, are very common in children. They may appear on one or both sides of the neck and are typically asymptomatic (without associated signs or symptoms) other than their presence. Less frequently, lymph nodes can increase in size quickly with associated pain and tenderness. Your child may have a fever and other evidence of upper respiratory tract infection. Such acute inflammation, known as lymphadenitis, suggests a bacterial infection that often requires antibiotic treatment.

Enlarged lymph nodes can sometimes be a sign of more serious concerns if they:

• are larger than 2.5 cm (1 inch) in diameter
• occur in infants and very young children
• are above the clavicle (collarbone) in adolescents and young adults
• appear attached to the overlying skin with no inflammation
• occur with weight loss, severe fatigue, or other symptoms of chronic illness

Neoplasms (tumors) of the neck

Fortunately, tumors of the head and neck are rare in children. Tumors within the neck may arise from lymph nodes (Hodgkin and non-Hodgkin lymphomas), from the muscles and soft tissues of the neck (rhabdomyosarcoma and other sarcomas), or from the endocrine and salivary glands of the neck (thyroid neoplasms and parotid neoplasms).

If your child’s doctors are concerned, they may order a diagnostic work-up, including a biopsy. This biopsy may involve removal of the entire tumor, a small piece of the mass, or a needle aspiration.

Congenital neck masses

Some children are born with masses that may appear at birth or at any time during childhood. These are known as congenital neck masses. Sometimes the sudden appearance of a congenital mass is related to secondary infection or trauma. Often a congenital neck mass will appear gradually and be detected during a routine examination by your child’s pediatrician.

Congenital neck masses are benign (non-cancerous). However, depending upon their size and location, they can potentially interfere with eating, drinking, breathing, or neck motion. When large, they can affect a child’s appearance.

There are different types of congenital neck masses, depending upon the location of the mass.

Midline congenital neck masses

Midline congenital neck masses include thyroglossal duct cysts, dermoid cysts, and foregut duplication cysts. A thyroglossal duct cyst is a mass or lump in the front part of neck that forms from remnants of the thyroid gland that fill with fluid. Sometimes the thyroid gland develops in an abnormal position; this condition is called an ectopic thyroid gland. Dermoid cysts can form in the center of the neck. A foregut duplication cyst can form from tissues typically found in the gastrointestinal tract or lungs.

Congenital neck masses of the anterior lateral aspect of the neck

These masses, which occur on either side of the neck, include branchial cleft cysts, dermoid cysts, and thymic cysts. Branchial cleft cysts can occur anywhere from the jawline to the clavicle. Dermoid cysts can form in the lateral neck. Thymic cysts form from remnants of the thymus gland. Sometimes a portion of the thymus gland itself can remain; this is called ectopic thymus.

A wide array of congenital vascular anomalies can also occur in both the front and back of the neck. Vascular anomalies are broadly divided into two categories — hemangiomas and vascular malformations. Lymphatic vascular malformations are the most common vascular anomaly that form in the neck.

How we care for neck masses

Surgeons in the Boston Children’s Hospital Department of Otolaryngology and Communication Enhancement and in the Department of Surgery have the expertise to diagnose and treat neck masses. Our surgeons work closely with medical oncologists and radiation therapists in the Head, Neck and Skull Base Surgery Program.