A congenital neck mass is a growth at birth that eventually becomes noticeable to the patient and family. Although the neck abnormality is present at birth, a lump may not appear until much later in life. The most common congenital neck masses are branchial cleft anomalies, thyroglossal duct cysts, lymphangiomas, hemangiomas and dermoid cysts.
Branchial cleft cysts or tracts are due to trapped tissue in the developing neck. They appear as a soft lump or draining opening in the side of the neck in the first years of life.There are three types of branchial cysts depending on the anatomy and its relationship to the adjacent blood vessels and nerves. A CT scan can allow the doctor to identify the exact location of these cysts. Surgical removal is advised since these cysts can get infected or become abscessed which would require a drainage procedure before definitive removal.
Thyroglossal duct cysts are remnants of the thyroid gland migration from the base of tongue into the neck, a process that occurs in the uterus. These cysts show up from childhood to adulthood as a soft, nonpainful lump in the midline of the upper neck. Surgical removal is recommended before these cysts 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 examination and Magnetic resonance imaging (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 protruding from the facial area and sometimes involving the windpipe below the voice box. Hemangiomas start growing shortly after birth and reach a peak at 2 years of age. They start to shrink over the next several years. MRI is used to diagnose this tumor. Steroids may be given to shrink the hemangioma, and in severe situations, surgical intervention using laser technology may be required
A dermoid cyst is a mass containing skin elements (hair, skin, and skin 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 a painless swelling in the midline face that is evaluated by CT scan or MRI to assess any extension from the forehead or nose into the skull bone. Surgical treatment may be simple, unless the MRI shows the tumor to extend into the skull, in which case a neurosurgeon may be needed.