A head or neck mass may be triggered by a variety of causes, including infection, tumors or cysts or masses formed while in the womb.
Conditions related to pediatric head and neck masses include:
- Branchial cleft anomaly. A branchial cleft anomaly is a cyst that develops in one or both sides of a child’s neck or below the collarbone. This condition is a birth defect and is also known as branchial cleft or pharyngeal arch remnant.
- Thyroglossal duct cyst. A thyroglossal duct cyst is a neck mass or lump that develops from cells and tissues left behind after the formation of the thyroid gland while a child is developing in the womb. Such cysts are most common in preschool-aged children or children in mid-adolescence, and they most often appear after an upper respiratory infection causes the cyst to become enlarged and painful.
- Enlarged lymph nodes. Enlarged (swollen) lymph nodes usually occur because of exposure to bacteria or viruses.
- Neck abscess. A neck abscess occurs when pus from an infection—such as a cold, tonsillitis, a sinus infection or an ear infection—gathers in the spaces between the structures of the neck. Neck abscesses are also known as cervical abscesses or deep neck infections.
- Head and neck cancer (tumors). Rare in children, head and neck cancer covers a group of cancers that can occur in the oral cavity, pharynx, larynx, paranasal sinuses and nasal cavity or the salivary glands.
Symptoms of a branchial cleft anomaly include:
- Dimple, lump or skin tag on the neck, upper shoulder or just below the collarbone
- Fluid draining from the neck
- Swelling or tenderness in the neck, usually combined with an upper respiratory infection
The most common symptoms of a thyroglossal duct cyst are:
- Small, soft, round mass in the center of the front of the neck
- Tenderness, redness and swelling of the mass (if infected)
- Small opening in the skin near the mass with drainage
- Difficulty swallowing
The main symptoms of enlarged lymph nodes include:
- Tender and painful lymph nodes
- Swollen lymph nodes that may be the size of a pea or kidney bean or even larger
Depending on the cause of the enlarged lymph nodes, your child may also experience:
- Runny nose, sore throat or fever
- General swelling of the lymph nodes throughout the body
- Hardened, fixed and rapidly growing nodes
- Night sweats
Symptoms of a neck abscess can include:
- Red, swollen, sore throat (sometimes on only one side) or bulge in the back of the throat
- Tongue pushed back against the throat
- Neck pain or stiffness
- Ear pain
- Body aches or chills
- Difficulty swallowing, talking or breathing
Symptoms of head and neck cancer include:
- Long-lasting sore throat or difficulty swallowing
- Change or hoarseness of the voice
- Mass in the neck or elsewhere in the head
Your child may exhibit additional symptoms based on where the tumor is located. Symptoms of cancer of the oral cavity include:
- White or red patching on the gums, tongue or lining of the mouth
- Swelling of the jaw
- Unusual bleeding or pain in the mouth
Symptoms of cancer of the pharynx include:
- Difficulty breathing or speaking
- Pain while swallowing or long-lasting pain in the neck or throat
- Frequent headaches
- Pain in the ears
- Difficulty hearing
Symptoms of cancer of the larynx include:
- Pain while swallowing
- Pain in the ears
Symptoms of cancer of the paranasal sinuses and nasal cavities include:
- Chronic sinus infections that do not respond to antibiotic treatment
- Nose bleeds
- Frequent headaches, swelling or other trouble with the eyes
- Pain in the upper teeth
- Blocked sinuses that will not clear
Symptoms of cancer of the salivary glands include:
- Swelling under the chin or around the jawbone
- Numbness or paralysis of the muscles in the face
- Persistent pain in the face, chin or neck
Many of the above symptoms occur with much more common, less severe conditions, so it is important for your child to be evaluated by a doctor in order to accurately diagnose head and neck cancer.
Diagnosis of Head & Neck Masses
To diagnose a head or neck mass, a pediatric ear, nose and throat specialist will perform a physical exam and review your child's medical history and current symptoms to narrow down the cause of symptoms.
A branchial cleft anomaly can be diagnosed using the following exams and tests:
- Physical exam. Your child's doctor will examine the neck and collarbone area to check for cysts.
- Imaging tests. The doctor may also order imaging tests such as magnetic resonance imaging (MRI), computed tomography (CT) or ultrasound to pinpoint the exact location of the anomaly.
A thyroglossal duct cyst can be diagnosed using the following exams and tests:
- Physical exam. Your child’s doctor will examine the throat and neck for signs of a cyst.
- Blood test. The doctor may order a blood test to assess your child’s thyroid function.
- Ultrasound. Ultrasound can be used to evaluate the mass and surrounding tissues.
- Thyroid scan. A thyroid scan is a type of nuclear medicine test that your child’s doctor may order to check the function of the thyroid.
- Fine needle aspiration. A fine needle aspiration is a type of biopsy that uses a thin needle to gather tissue that will be analyzed in a lab.
Enlarged lymph nodes can be diagnosed using the following exams and tests:
- Physical exam. The doctor will examine the lymph nodes near the surface of the skin for size, tenderness, warmth and texture.
- Blood test. Depending on what the doctor suspects is causing the enlarged lymph nodes, he or she may order a complete blood count (CBC) blood test to evaluate your child’s overall health and check for a range of conditions, including infections and leukemia.
- Imaging tests. Imaging tests such as an X-ray or CT scan can help the doctor determine potential sources of infection or to locate tumors.
- Biopsy. The doctor may remove a tiny sample of the enlarged lymph node for closer analysis in the lab.
A neck abscess can be diagnosed using the following exams and tests:
- Physical exam. The doctor will examine your child’s neck for the presence of an abscess.
- Throat culture. A throat culture involves collecting cells by swabbing the back of the throat. The tissue sample is sent to a laboratory to determine the type of organism causing the infection.
- Blood test. A blood test may be performed in order to measure the body’s response to infection.
- Biopsy. The doctor may remove a tiny sample of the abscess for closer analysis in the lab. Generally, if the doctor operates on a neck abscess to obtain the biopsy sample, he or she will also make an incision and drain the area.
- Imaging tests. The doctor may order an X-ray or CT scan in order to get a more detailed look at the abscess and surrounding tissues and bones.
Head and neck cancer can be diagnosed using the following exams and tests:
- Physical exam. A complete physical exam will be performed, including checking the location and size of the head or neck mass.
- Biopsy. The doctor will remove a sample of tissue from the mass to confirm if it is benign or malignant (cancerous).
If your child has a branchial cleft anomaly accompanied with signs of infection, the doctor will likely prescribe antibiotic medicines to fight the infection. The doctor may also need to drain fluid from the cyst to reduce swelling. In some cases, surgery may be needed to prevent future infections. This surgery is usually an outpatient procedure performed under general anesthesia. Recovery is relatively short, and your child can usually resume normal activity within a few days.
If your child has a thyroglossal duct cyst, the doctor may prescribe antibiotic medicine to treat the infection or recommend surgery to remove the cyst and the thyroglossal duct. This procedure is known as the Sistrunk procedure.
If your child has enlarged lymph nodes, treatment will depend on the underlying condition causing the condition. If the swollen lymph nodes are caused by a bacterial infection, the doctor may prescribe a course of antibiotic medicine. If they are caused by certain rheumatologic conditions, such as lupus or arthritis, the doctor will treat that underlying condition. If the swollen lymph nodes are caused by cancer, the cancer will need to be treated with surgery, radiation therapy and/or chemotherapy.
If your child has a neck abscess, the doctor may prescribe antibiotic medicine to treat the infection. Depending on your child’s specific condition, the abscess may need to be drained through surgery using a needle. This procedure may require hospitalization.
The treatment of head and neck cancer is based on the location of the tumor, stage of the cancer and your child’s overall health. The doctor may recommend surgical removal of the tumor and chemotherapy or radiation therapy to shrink the tumor.
Key Points to Remember
Key Points to Remember
- The main types of head and neck masses are branchial cleft anomaly, thyroglossal duct cyst, enlarged lymph nodes, neck abscesses and head and neck cancer.
- The first step of diagnosis of any head and neck mass is a thorough physical exam.
- Your child’s doctor may recommend additional imaging tests or a biopsy to make a definitive diagnosis.
- Head and neck cancer is very rare in children, and it shares symptoms with many other more common conditions.
Support Services & Resources
Support Services & Resources
Visit the trusted websites below for more information and support for pediatric head and neck masses.
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
The American Academy of Pediatrics shares facts about swollen lymph nodes on its website, healthychildren.org.
This government organization provides detailed information about head and neck cancers.