Head and Neck A17


Neck lumps (paediatrics)

The majority of neck lumps in the paediatric population are benign and can be divided by location: midline or lateral. 

Midline neck lumps:

thyroglossal cyst is the most common neck mass in children and forms as a cystic remnant of the thyroglossal duct. It can arise at any site along the route of the duct, extending from the tongue (foramen caecum) to the final position of the thyroid gland in the midline of the neck at the level of the thyroid cartilage. It presents as a midline swelling, commonly below the hyoid bone, and moves on swallowing & tongue protrusion. Treatment is by elective surgical excision – Sistrunk procedure [with removal of central portion of hyoid bone +/- core of central tongue muscle to prevent recurrences].

Dermoid cysts also present as midline neck swellings but are less common than thyroglossal cysts, and may or may not move on swallowing or tongue protrusion. The cysts are lined by epidermis and contain dermal structures, such as hair or teeth. They may be difficult to distinguish from thyroglossal cysts. Treatment is by elective surgical excision. 

chondroma is a rare midline neck lump, consisting of cartilaginous tissue. They are hard on palpation and move on swallowing. 

Lateral neck lumps:

Branchial cysts are remnants of the branchial clefts/pharyngeal pouches, presenting as a lateral neck swelling within the anterior triangle typically anterior to the upper third of sternocleidomastoid muscle. It is the most common lateral neck lump in children.

Correct Answer: