Congenital Neck Masses
The definition of a congenital neck mass is one that is present at birth. Although the neck abnormality is congenital, an actual lump may not appear or become noticeable to the patient and family until much later in life. The most common congenital neck masses are the branchial cleft anomalies, thyroglossal duct cysts, lymphangiomas, hemangiomas and dermoid cysts.
Branchial cleft cyst or tracts (figure 1) are due to trapped tissue in the developing neck of a fetus. They are discussed in detail on a dedicated page on our website. Surgical removal of branchial cleft cysts is advised since these cysts can get infected, which would require a drainage procedure before definitive removal.
Thyroglossal duct cysts (figure 2) are remnants of the thyroid gland migration from the base of tongue into the neck of a fetus. They are also discussed separately on our website. Surgical removal is recommended for thyroglossal duct cysts before they become infected.
Lymphangiomas are the result of an abnormal collection of lymph channels in the body. Extensive collections of fluids from these channels form cysts known as lymphangiomas or cystic hygromas. These cysts are not cancerous but by there invasive growth can cause significant cosmetic deformity. These lesions are evaluated by physical examination and MRI scan. Sclerosing agents injected into these cysts can help reduce the size by scarring the channels followed by surgical removal, which can be extensive.
Hemangiomas are bulging bluish-red masses under the skin that can appear as a facial or neck mass. Sometimes, they grow in the airway just below the larynx (voice box), which may create significant breathing problems for a baby (figure 3). Hemangiomas start growing shortly after birth and reach a peak at two years of age. They start to shrink over the next several years. An MRI scan is a helpful imaging study for diagnosing this benign but sometimes troublesome tumor. In addition, a diagnostic bronchoscopy may be done to visualize the hemangioma. This means that, under general anesthesia, a telescope is inserted through the mouth and down into the airway where the hemangioma sits. Steroids may be given in severe situations or surgical intervention utilizing laser technology may be recommended if spontaneous resolution does not occur.
A dermoid cyst (figure 4) is a mass containing skin elements (hair, skin and sweat glands) trapped under the skin usually located in an imaginary line from the middle of the forehead straight down to the lower neck. It is evaluated by CT scan or MRI. Surgical treatment may be simple, but occasionally dermoid cysts have a stalk that connects all the way to the brain. In these rare cases, a neurosurgeon is consulted.
