Surgical approach to evaluate neck mass in children concerning management protocols

Background: Neck masses in children are not common presentations in Head-neck specialized practice but when present they createpotential diagnostic dilemmas for consulting surgeon. These children may present as havingapparently simple harmless mass in the neckbut there are several alarming diagnostic possibilities. Attending surgeons should concern about the wide range ofdifferential diagnoses.

Objective: Differential diagnosis and management of Neck masses in children differ from those in adults. A systematic approach to diseases and judicious investigation protocol is crucial to ensure appropriate assessment and management. This prospective study was undertaken to assessmanagementprotocol for the evaluation process of neck mass in case of children.

Methods:This is a prospective study of 6 yearsin the tertiary hospital based in Dhaka between 2016 and 2022. 385 (131, girls, 254 boys) patients aged between 2 years to 14 years were reviewed. The history, physical examination findings, imaging reports (USG, color Doppler, CT, and MRI)FNAC, and the histopathology report are taken into consideration as managementprotocol for the evaluation process.

Results: In this studyauthors observed congenital masses were most commonly found in this age group, followed by Infectious and neoplastic masses, at a rate of 57.40%, 27.53%, and 15.06% respectively. Thyroglossal Cyst constituted 33.48% of congenital masses. Non-Hodgkin lymphoma was the most frequent type of malignancy (50%). The lateral neck was the most affected site (47.01%).

Conclusion: The diagnosis can be reached with a brief history and prompt physical examination. Ultrasound and Color duplex study should be the first choice for evaluation. Fine needle aspiration cytology followed by excisional biopsyfind out the tissue of origin. FNAC can guide the surgeon initially to reach the disease and give the clue for the next steps on evaluation. CT SCAN & MRI should be avoided if not clearly indicated as both need sedation in case of children and CT emits radiation effect.