The head and neck region has a wide anatomical structure in terms of lymph nodes, salivary glands, the thyroid gland, and soft tissues. As such, head and neck masses in children may develop from different sources. Neck masses in children often arise from benign causes, with a significant portion due to lymph node enlargement associated with infections. However, in some cases, the underlying cause needs proper evaluation. Not every palpable mass in the neck has the same implication; the duration, growth rate, accompanying symptoms, and the child's general condition are decisive in the diagnostic process.
What Are Neck Masses in Children?
Neck masses in children are defined as noticeable swellings or fullness in the front, side, or back areas of the neck. These masses are often a result of lymph node enlargement and are among the commonly observed head and neck masses in childhood. Not every neck swelling signifies a serious condition. Lymph node enlargements that develop during infection periods are usually temporary and benign.
Neck masses can arise from various sources. While the most common cause is reactive lymph node enlargement due to infections, congenital cysts, thyroid gland masses, or, rarely, salivary gland tumors can also manifest as swelling in the neck.
Why Do Neck Masses Occur in Children?
There can be multiple reasons for the appearance of swellings noticed in the neck area in children. Although neck masses in children are most commonly due to lymph node enlargement related to infections, congenital structures, thyroid diseases, and rarely tumor formations can also lead to a neck mass appearance. Therefore, the duration of the mass, growth rate, accompanying symptoms, and the child's general health condition provide important clues in the evaluation.
Lymph Node Enlargements Due to Infections
The most common cause of neck masses in children is reactive lymph node enlargement due to infections. Particularly during upper respiratory tract infections, the immune system is activated, and lymph nodes may enlarge temporarily.
Commonly associated with:
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Upper respiratory tract infections
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Tonsil and adenoid infections
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Middle ear infection
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Tooth and mouth infections
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Infections causing nasal congestion
These types of masses are generally painful, soft, and mobile; they tend to decrease in size as the infection subsides.
Enlarged Tonsils and Adenoid Problems
In childhood, enlarged tonsils and adenoids, which are frequently observed, can stimulate the lymph nodes in the neck. Recurrent infections, which can be counted among the harms of enlarged tonsils, may lead to noticeable changes in neck lymph nodes.
Nasal congestion due to adenoid enlargement, mouth breathing, and frequent infections can also set the stage for temporary neck swellings.
Congenital Masses
Some neck masses are due to congenital developmental anomalies. These masses are usually painless and often noticed by the family incidentally.
The most commonly seen congenital masses include:
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Thyroglossal duct cyst
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Branchial cleft cysts
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Dermoid cysts
These formations can remain stable for long periods unless infected but may grow or become inflamed over time.
Salivary Gland Tumors
Although rare in childhood, salivary gland tumors can present as masses around the neck and jaw. Such masses are typically:
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slow-growing,
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painless,
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distinct palpable swelling
Early evaluation is crucial for distinguishing between benign and malignant.
Thyroid Gland Masses
Swelling located at the anterior midline of the neck should consider thyroid gland masses in differential diagnosis. Although thyroid nodules are less common in children compared to adults, they should be carefully evaluated.
In thyroid-related masses:
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swelling that moves with swallowing,
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fullness in the anterior part of the neck,
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rarely voice changes
such findings may be observed.
What Are the Symptoms of a Neck Mass?
Neck masses in children are often noticed as a palpable swelling in the neck. They can arise for various reasons, from temporary lymph node enlargements due to infections to congenital structures or rarely salivary gland ones. Symptoms may vary based on the cause of the mass.
Common symptoms that may accompany a neck mass include:
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Palpable swelling in the neck
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Tenderness and pain
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Fever
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Upper respiratory infection symptoms
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Nasal congestion
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Difficulty swallowing
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Snoring and mouth breathing
How Are Neck Masses in Children Diagnosed?
The first step in evaluating swellings noticed in children's necks is a medical examination. Although neck masses in children are often due to infection-related lymph node enlargement, the cause of the mass is investigated based on its duration, growth rate, and structure.
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Physical Examination
A physical examination is performed to evaluate the location, size, firmness, and mobility of the mass. Additionally, tonsils and upper respiratory symptoms are examined to investigate whether the masses are related to infections of the head and neck.
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Radiological Imaging
In necessary situations, neck ultrasound is the method used. Ultrasound can help determine whether the mass belongs to a lymph node, cyst, or glandular tissue.
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Advanced Examinations
In suspicious cases, blood tests, advanced imaging, or a biopsy may be planned. A detailed evaluation is conducted if thyroid gland masses or rare salivary gland tumors are suspected.
How Are Neck Masses in Children Treated?
The treatment of neck masses in children is planned according to the underlying cause of the mass. If there is lymph node enlargement related to infections, medical treatment and follow-up may suffice in many cases. Therefore, not every neck swelling should be seen as requiring surgery.
Treatment of Infection-Related Masses
In lymph node enlargements associated with upper respiratory infections, tonsillitis and nasal congestion, the underlying infection is primarily treated. After appropriate treatment, the mass generally reduces and disappears within a few weeks.
Cases Requiring Follow-Up
Some reactive lymph nodes may not disappear immediately after treatment. Such head and neck masses are often monitored at regular intervals to check if they are reducing.
Masses Requiring Surgery
In cases of congenital cysts, permanent masses, or gland-related formations, surgical treatment may be considered. Especially if:
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There are thyroid gland masses,
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Salivary gland tumors,
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infected congenital cysts
are present, the treatment plan is determined by a specialist physician.
Frequently Asked Questions
Do Enlarged Tonsils Cause Swelling in the Neck?
Yes, children who frequently experience tonsil infections may have reactively enlarged neck lymph nodes. This condition often regresses when the infection is treated.
Are Salivary Gland Tumors Seen in Children?
Although rare, salivary gland masses can develop in children. If a permanent swelling is noticed under the jaw or in front of the ear, it is recommended to consult an ENT specialist.
Which Department Should a Child with a Neck Mass Be Taken To?
The initial evaluation is generally conducted by an Otolaryngology (ENT) specialist. In necessary situations, it may be planned to have evaluations with related branches such as pediatrics and endocrinology.
Is Every Palpable Mass in a Child's Neck Dangerous?
No, the great majority of neck masses in children are benign lymph node enlargements related to infections. However, if the swelling does not subside over a long period or tends to grow, a specialist evaluation is recommended.
