Pediatric Neck Research Articles

Failure factors in pediatric deep neck space abscess surgical management.

Deep neck space infections (DNSI) in pediatric otolaryngology are a common occurrence in the inpatient setting. A subset of DNSI patients will fail medical and surgical management. It is difficult to predict which patients will fail. There are no studies that effectively evaluate variables associated with readmission and reoperation for DNSI abscesses. The purpose of this study was to evaluate the specific perioperative decisions that may lead to combined therapy failure and necessitate reoperation. A case-control study was performed at a single center academic tertiary care hospital. Patients <18 years old treated from January 2015 to April 2020 with a surgically treated DNSI were reviewed. The single incision and drainage group (SOp) and reoperation group (ReOp) were evaluated with reoperation performed within a 30-day period. Intravenous antibiotic administration timing, drain management and type (gauze or latex), diagnostic, and postoperative factors were evaluated. The SOp group consisted of 275 patients and the ReOp group of 21 patients. The average preoperative intravenous antibiotic time showed no statistical difference (p=0.884) and no increased risk for reoperation (p=0.470; OR=0.993). Timing of drain removal showed a significant difference (p<0.005; 41.1 SOp vs 46.5h ReOp). Abscess location (p=0.855) and complications rate did not vary (p=0.450). Gauze drains were used in 131 (44.3%), latex in 80 (27%), and no drain in 84 (28.4%) with no difference regarding reoperation (p=0.124). Length of stay was longer in the ReOp group (8 vs 4 days; p<0.001). The average measured dimension for each group did not significantly vary (p=0.633). The duration of antibiotics in the preoperative period showed no statistical role in the need for reoperation in DNSI abscess patients. Drain type and duration also had a potentially clinically relevant association with the need for reoperation. Extensive unknown abscess pockets or inadequate technique may be the main contributors to the need for reoperation.

Closed Reduction Technique for Severely Displaced Radial Neck Fractures in Children.

The described technique is useful for achieving closed reduction of severely displaced (i.e., Judet Type-III and IV) pediatric radial neck fractures. It is widely agreed that radial neck fractures with angulation of >30° should be reduced. Various maneuvers have been described, but none uniformly achieves complete reduction in severely displaced radial neck fractures (Types III and IV)1-4. The aim of the present technique is to achieve closed reduction in these severely displaced radial neck fractures without surgical instrumentation. A stepwise approach is described. First, the radial head is viewed in profile under an image intensifier so that it appears rectangular. Varus stress is applied at the medial aspect of the elbow by the assistant, and thumb pressure is applied at the radial head along the posterolateral aspect of the elbow. This results in partial reduction of the radial head. The elbow is then simultaneously flexed and pronated with continuous pressure over the radial head. This final step anatomically reduces the radial head, and hyperpronating the forearm locks it in the corrected position. Operative alternatives to this technique include intra-focal pin-assisted reduction to achieve closed reduction, the Métaizeau technique of achieving indirect closed reduction of the fracture with the aid of a TENS (Titanium Elastic Nailing System) nail, and open reduction5. Nonoperative techniques have also been described for use with Judet Type-II and III fractures, but not with the severely displaced types described in the present article. This technique takes into consideration the anatomy of the capsule and lateral collateral ligament complex. The biomechanical ligamentotaxis helps in achieving anatomic reduction of the radial head. Placing the forearm in pronation tightens the annular and lateral collateral ligaments and prevents redisplacement. There are potential complications with operative treatment, including the risk of nerve injury with percutaneous reduction techniques and the risks of osteonecrosis, premature epiphyseal fusion, and heterotopic ossification with open reduction. These complications can be avoided by the use of the presently described technique. This technique provided satisfactory clinical outcomes in our previous study6, with none of the 10 patients showing signs of growth disturbance, loss of reduction, or reported complications at 12 months. Terminal restriction of supination was observed in 1 patient. No patient had osteonecrosis or elbow deformity. No patient required conversion to an implant-assisted or open reduction procedure. The steps need to be followed sequentially as described in order to achieve an anatomical reduction.After achieving the reduction, it is necessary to keep the forearm in pronation to maintain the reduction with the aid of the lateral ligament complex.This technique may not work in complex fractures with elbow dislocation because of the lack of ligamentous integrity.In the final step, the elbow is pronated and flexed simultaneously, with sustained pressure over the radial head in order to obtain further correction. This is the most critical step of the technique because anatomic reduction of the partially reduced fracture is achieved at this time. Percut. = percutaneousAP = anteroposteriorCR = closed reductionORIF = open reduction and internal fixation.

Paediatric head and neck malignant neoplasms: A brazilian retrospective study.

To assess the prevalence of oral and maxillofacial malignant neoplasias in children and adolescents diagnosed through biopsies sent to the Oral Pathology Laboratory at the University of Sao Paulo School of Dentistry. A retrospective analysis of anatomopathological reports on patients between 1 and 18 years old issued by the oral and maxillofacial pathology laboratory between 1997 and 2021 was performed for demographic data, lesion site, type of biopsy, diagnostic hypothesis and final diagnosis. The laboratory issued 76,194 anatomopathological reports during this period, of which 10.77% were of children and adolescents. Of this total, only 32 biopsies (32/8.204; 0.39%) were neoplasias in children and adolescents. Sarcomas were the most prevalent malignant neoplasms (19/32; 59%), followed by carcinomas (7/32; 22%), lymphomas (5/32; 16%) and ganglioneuroblastomas (1/32; 3%). Of these 32 patients, the most affected individuals were aged between 4 and 11 years old (47%), 18 (56%) were male, and the mandible was the main anatomical site involved (28%). In 41% of the cases (13/32), the diagnostic hypothesis of the biopsied lesion was mistakenly considered benign and there was no diagnostic hypothesis in 18% of the cases. Oral and maxillofacial malignant neoplasms in children and adolescents are uncommon and the accuracy of provisional diagnoses is low in these cases. Better knowledge on oral and maxillofacial malignant lesions in this population would help professionals to reduce the diagnostic time and consequently improve the patient's prognosis.

Surgical vs interventional radiology drainage of neck abscesses in pediatric patients.

To compare outcomes using an open surgical incision and drainage (S-ID) versus an aspiration under interventional radiology drainage (A-ID) of pediatric neck abscesses. The primary outcome measure was successful drainage requiring one intervention, and the secondary outcome measures were readmission rates and overall cost to the healthcare system. Retrospective data collection of all pediatric patients treated at the Primary Children's Hospital for neck abscess from 2008 to 2020. Patients who did not require drainage were not included. Comparison between S-ID and A-ID was performed according to the primary and secondary outcomes. Two hundred fifty nine patients were included in the study. Twenty-six patients had A-IR and 234 patients had S-ID. Patient demographics were not significantly different between both groups. Overall length of stay was greater in the A-ID group (5 vs 3.3 days) (p<0.05). A second procedure was more frequent in the A-ID group with 11/26 (42%) versus 12/234(5%) in the S-ID group (P=0.001) even after controlling for multiple possible confounding factors. The rate of readmission was also higher in the A-ID group with 3/26 (11%) versus 7/234 (3%) in the S-ID group (P=0.006). Both groups showed similar overall cost (P=0.621). A-ID and S-ID are both methods to treat head and neck abscess requiring drainage. However, overall results indicate a higher rate of failure requiring a second intervention and a higher rate of readmission in the A-ID group. In our study cost was noted to be similar between both methods.

COVID-19 Impact on Operative Management of Pediatric Neck Abscesses.

Introduction For multiple reasons, elective pediatric otolaryngology surgical procedures have declined during the COVID-19 pandemic. Objective The purpose of the present study was to assess whether the prevalence of pediatric neck abscesses managed with operative drainage decreased compared with previous years. Methods Medical records of all pediatric cases at a tertiary care children's hospital diagnosed with abscess of the neck and treated with incision and drainage were evaluated between the dates of April 1 and November 30 from 2015 to 2020. Outcomes were compared for each year from 2015 to 2019 to 2020, which included location, abscess size, duration of antibiotic treatment, microbiology, and the number of cases per year. Results A total of 201 cases were included. The mean ± standard deviation (SD) presenting age in the 2015 to 2019 group was 5.05 ± 5.03 years old and 2.24 ± 1.91 years old in the 2020 group. The mean number of cases between 2015 and 2019 was 35.6 ± 4.2, whereas the number of cases in 2020 was 23 ( p = 0.002). Of those patients who underwent IV antibiotic therapy prior to presentation ( n = 43), the mean number of days before admission was 1.98 ± 2.95 ( n = 40) from 2015 to 2019 and 12.00 ± 10.39 ( n = 3) in 2020 ( p = 0.008). The percent of cases with multiple strains cultured between 2015 and 2019 was 13.4% versus 18.2% in 2020 ( p = 0.007). Conclusion There was a decrease in the number of operative neck abscesses in 2020 compared with the mean number per year from 2015 to 2019. COVID-19 mitigation strategies leading to reduced transmission of other viral and bacterial illnesses and a tendency toward prolonged medical management to avoid surgery are two possible explanations.

Cytopathological Evaluation of Paediatric Non-Thyroidal Neck Swelling–Experience in a Tertiary Care Children Hospital

Background and Objective: Fine needle aspiration cytology (FNAC) is well accepted as a useful diagnostic technique in the management of adult patients with head and neck lumps. However, until recently, few reports have been obtained regarding the role of FNAC in non-thyroidal neck masses in children. Therefore, the objective of our study was to determine the diagnostic value of fine needle aspiration cytology in the diagnosis of pediatric non-thyroidal neck masses. Methods: This descriptive study was conducted at the Department of Pathology of Bangladesh Shishu (Children) Hospital &amp; Institute January 2019 to December 2021. Hundred patients with non-thyroidal neck masses fulfilling the inclusion criteria were included in the study. Fine needle aspirations were performed, smears prepared and stained by Hematoxylin and Eosin stain. Results: The most common non-neoplastic neck swelling seen in children were an enlarged lymph node due to inflammation 38(42.2%), i.e., reactive lymphadenitis. Others were TB lymphadenitis 25 (27.8%), non-TB granulomatous lymphadenitis 2(2.22%), chronic sialadenitis 2(2.22%), branchial cyst 4(4.44%) and epidermal cyst 3(3.33%) cases. Overall sensitivity, specificity, positive predictive value and negative predictive value of FNAC in our cases are 93.06%, 72.22%, 93.06% and 72.22%. Conclusion: FNA is an important diagnostic tool in the management of childhood neck lesion with the clinical presentation. The procedure decreases the requirement for more invasive and costly procedures like surgical biopsy.

Imaging of pediatric head and neck tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee/ASPNR White Paper.

Imaging of pediatric head and neck tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee/ASPNR White Paper.

Pediatric Head and Neck Malignancies

Head and neck masses represents a common clinical entity in pediatric age group. In general, these masses are classified in to developmental, inflammatory, or neoplastic. Having a working knowledge of these lesions in head and neck region &amp; conducting a thorough history &amp; physical examinations generally enable the clinician to simplify an appropriate workup and establish a diagnosis. The differential diagnosis is wide-ranging, and expeditiously distinguishing the benign from malignant masses is difficult for instituting a timely multidisciplinary approach to the management of malignancy. Malignancy of the head and neck account for approximately 5% of all childhood carcinomas. This review aims to discuss the most common head and neck malignancies in childhood. The evidence for the diagnosis and management of childhood, head and neck malignancy is summarized. The rarity of these tumors are inevitably results in a paucity of high-level evidence to guide the treatment. Keywords: Children, Head and neck malignancy, Lymphoma, Malignancy, Rhabdomyosarcoma

New surgical frontiers for 4K 3D-exoscope in paediatric head and neck surgery.

To define the interest, advantages, and disadvantages of the use of a 3D-exoscope in paediatric ENT surgery. Four surgeons with experience in paediatric surgery completed a questionnaire following each surgery performed under 3D-exoscope to evaluate the contribution of the tool compared to the usual practice (microscope or magnifying loupes). Surgeries were separated into three groups: otology, transoral and cleft palate surgery, and open head and neck surgery. Between June 2021 and June 2022, 151 paediatric surgeries were included in this study. Among them, 93 (62%) otologic surgeries, 35 (23%) transoral surgeries, and 23 (15%) head and neck surgeries were performed. The median age at surgery was 68months (interquartile range 19-135months). For otologic surgeries, the mean scores (/100) for the contribution of the exoscope compared to the microscope were 68.4(± 23.2). For transoral and cleft palate surgery, the mean score (/100) for the contribution of the use of the exoscope compared to the magnifying loupes was 92.9 (± 8.6), whereas for open head and neck surgeries, the mean score (/100) was 89.5 (± 7.2). 3D-exoscopy appears to be a relevant tool for paediatric head and neck surgery, applicable in otologic, transoral, and cervical fields. It presents educational and ergonomic advantages and improves surgical team communication.

Outcomes of Closed Reduction and Internal Fixation (CRIF) by Cannulated Cancellous Hip Screw in Transcervical Fracture Neck of Femur in Children

Introduction: Fracture of the neck of the femur is one of the most common and difficult problems all over the world, for all ages. As the femur is the weight-bearing bone in the lower limbs, fracture of the neck femur creates severe problems like shortening, limping, and a painful unstable hip. The incidence of pediatric neck fractures is highest in children above the age of eleven. The most common cause is high-energy trauma such as motor vehicle accidents and falls from height, also osteogenesis imperfecta, and myelomeningocele. This study aimed to analyze the outcomes of closed reduction and internal fixation (CRIF) by the cannulated cancellous hip screw in the transcervical fracture neck of the femur in children. Methods: This prospective interventional study was conducted at the National Institute of Traumatology &amp; Orthopedic Rehabilitation (NITOR), Dhaka, from July 2011 to June 2013. A total of 16 patients were selected for this study as per inclusion criteria. All statistical analysis of different variables was analyzed according to the standard statistical method by using SPSS. Result: In this study, the age of the patients ranged from 5-18 years with an average age of 11.25 years. The majority of the patients (56.25%) belonged to the age group 10-14 years, followed by 31.25% in the age group 5-9 years, and the rest 12.50% in the 15-18 years age group. Out of 16 patients, 10 patients (62.50%) were male and 06 patients (37.50%) were female. In the present study, the anatomical reduction was achieved in 07 (43.75%), the acceptable reduction was achieved in 05 (31.25%), and the unacceptable reduction in 04 (25.0%). The average time interval between injury and operation was 7.3 days, out of 16 study cases, 10 cases operated within 7 days of which 9 were united (90.0%), and 6 cases were operated after 7 days, of which 4 (66.66%) were united. Out of 16 patients, 12 (75.0%) regained full range of hip movement and 04 (25.0%) patients had limited range of motion. ...

What is this bump in my neck? Ultrasonographic evaluation of pediatric neck masses.

Neck masses are common in pediatric patients, with benign etiologies such as congenital or inflammatory lesions accounting most of these masses. Anatomic location (most important), clinical history, and the appearance in ultrasonography (US) are helpful clues to narrow down differential diagnosis. Because of widespread availability, lack of ionizing radiation, and no need for sedation or contrast administration, US is the preferred initial modality for the evaluation. Further evaluation with cross-sectional imagings is needed for more extensive lesions with trans-spatial extension or suspicion of intrathoracic or retropharyngeal extension. This review will focus on US appearance and clinical presentation of masses of the neck in children, to enable radiologist to arrive at a reasonable differential diagnosis. We also briefly discuss more complex pathologies that need to be evaluated with cross-sectional modalities such as CT scan and magnetic resonance imaging.

13-month-old female with left neck swelling.

A 13-month-old female was brought to the emergency department by her mother for 2 days of left neck swelling (Figure 1). Per her mother, the patient had developed progressive swelling and erythema after scratching the area over the last week. Otherwise, she was asymptomatic with normal vital signs. Before the patient's swelling, there had been a “dimple” at the area since birth. A point-of-care ultrasound was performed, demonstrating a 2.1 × 2.3 × 2.1 cm cystic and heterogeneous structure (Figure 2). Infected Branchial Cleft Cyst. Branchial cleft anomalies are remnants of branchial cleft mucosa during embryogenesis.1, 2 Incomplete involution of the mucosa create vestigial cysts, sinuses, and/or fistulas. There is a predilection for branchial cleft anomalies on the left side, more common in females, and second branchial cleft anomalies are the most common.3 Branchial cleft cysts present as a painless soft tissue mass around the anterolateral neck, along the anterior sternocleidomastoid muscle. If infected, they can become swollen and tender. Rarely, the cyst can lead to complications of airway compromise and glossopharyngeal and hypoglossal nerve compression due to mass effect.4 Clinical and radiological diagnostics can raise suspicion for branchial cleft cysts. Definitive diagnosis is made with cyst excision and histological examination, demonstrating a cystic cavity lined by epithelium and underlying connective tissue showing germinal centers.4 Other diagnoses to consider for pediatric superficial neck masses are lymphadenopathy, thyroglossal duct cyst, or dermoid cyst. Conservative treatment of needle aspiration, incision and drainage, and injection of sclerosant agents may be trialed, but recurrence is common.1-4 Definitive treatment is surgical excision.

Exploration of dose-toxicity for ophthalmological adverse events in pediatric head and neck rhabdomyosarcoma survivors

<h3>Objectives</h3> Ophthalmological adverse events (OAEs) following local treatment for pediatric head and neck rhabdomyosarcoma (HNRMS) are prevalent. More knowledge on specific radiation dose-toxicity relationships for ophthalmological organs at risk (OARs) in children can help to avoid these OAEs. The aim of the present study is to explore the dose-toxicity probability for multiple OAEs seen in long term HNRMS survivors. <h3>Methods</h3> Clinical data on OAEs were systematically assessed in an international cross-sectional cohort that included survivors of pediatric HNRMS with ≥2 years follow-up. Dosimetric data were collected from the original radiotherapy treatment plans. OARs were delineated on the 3D radiotherapy planning CTs. Dose-toxicity probability curves were constructed using binary logistic regression. <h3>Results</h3> 74 eyes in 38 survivors with a median follow-up time of 9 years (range 2 – 27) were analyzed. With the exception of epiphora, dose-toxicity probability curves with good model-fit (AUC under ROC ≥0.8) were constructed for all OAEs. A >20% probability of globe displacement, dry eyes and/or cataract (any grade) at follow-up was seen for mean doses of >40, 10 and 6 GyEQD2 to the orbital bones, lacrimal gland and lens respectively. Retinopathy and optic neuropathy only occurred in eyes receiving maximum doses > 40 and 53 GyEQD2 to the retina and optic nerve respectively. No multivariable analyses were conducted because of low numbers of events per OAE. <h3>Conclusion</h3> We offer the first detailed description of specific dose-toxicity probability for ophthalmological OARs in children derived from clinically assessed OAEs in long-term survivors. These results are critical to: 1) quantify expected variation in clinical toxicity between different treatment techniques, 2) understand the additional OAEs children will incur if prescription dose for orbital RMS is increased from 45 Gy to 50.4 Gy on future clinical trials, and 3) inform physicians and future patients about expected long-term toxicity and necessary surveillance.

Perceptions of telemedicine at a pediatric otolaryngology-head and neck surgery program

ObjectiveWith few studies investigating the effectiveness of telemedicine (TM) in pediatric otolaryngology (ear, nose, and throat; ENT), its role in clinical practice is unclear. The objective of this study was...

Study of Short-Term Outcome of Surgically Managed Displaced Pediatric Radial Neck Fractures: A Case Series.

Pediatric radial neck fractures are relatively rare elbow injuries commonly seen in children between eight to 12 years of age. Judet type III and Judet type IV radial neck fractures require surgical intervention for optimal functional outcomes. The present study evaluates the functional results of Judet type III and IV radial neck fractures operated at a single center. This is a retrospective study conducted by using medical records of nine patients who had displaced radial neck fractures (Judet type III and type IV) treated at our institute which is a tertiary trauma care centerbetween January 2012 andDecember 2021. Patients were assessed for functional outcome by Mayo elbow performance score (MEPS), the Tibone and Stoltz functional criteria, and for complications with the average follow-up of four years(range: six months to seven years). Results: The mean age of the patients was 9.14 ± 2.2 years (range: four to 11 years). Seven (77.8%) patients were males and two (22.2%) patients were females. The right side was the most commonly injured side (right at 67%, left at 33%). Five (55%) cases were of Judet type III and four (45%) cases were of Judet type IV.Three cases treated with closed reduction and intramedullary nailing by the Metaizeau technique had excellent functional results. Among two patients treated with percutaneous pin leverage and intramedullary nailing by the Metaizeau technique, one patient had an excellent outcome, and the other had a good outcome. Among four casestreated with open reduction and K-wire fixation, two patients had good outcomes, one patient had a fairoutcome, and one patient had a poor outcome. The majority of moderately to severely displaced pediatric radial neck fractures which need intervention can be managed by the closed reduction technique of Metaizeau with or without pin leverage with excellent to good functional outcomes at short-term follow-up. Some cases need open reduction which also has good to fair outcomes. Initial trauma and associated injuries seem to play a role in the outcome rather than the treatment method per se. However, a larger sample size and longer follow-up are needed for comparisons and for arriving atbetter and definitive conclusions.

Lessons learnt from the global iodinated contrast media shortage in head and neck imaging.

A recent shortage in the global supply of iodinated contrast media (ICM) has required health service providers to review their contrast administration policies and implement strategies to conserve inventory. This article will review the current best practices in head and neck imaging for a variety of common presentations and provide examples where alternative imaging can be considered due to the recent ICM shortage. Ultrasound and MRI techniques can feature heavily in many diagnostic processes in head and neck pathology, and a variety of common presentations can be appropriately investigated through clinical evaluation or naso-endoscopy. In many instances, for the routine assessment of non-acute adult and paediatric head and neck presentations, the use of contrast-enhanced CT can be safely minimised to conserve ICM if required.

Common Pediatric Neck Lesions: A Pictorial Review

Pediatric neck lesions cover an expansive list including both benign and malignant entities. The ability to differentiate among these lesions is imperative to appropriately navigate management. Using a multimodality approach, this article clearly illustrates and describes the most common pediatric neck lesions to help make the task of differentiating these lesions more attainable.

Oral Premalignant and Malignant Lesions in Fanconi Anemia Patients.

There is a lack of data supporting cancer surveillance in pediatric Fanconi Anemia patients. We sought to describe the rates of upper aerodigestive lesions and malignancy in this population to augment current management guidelines. A retrospective cohort study of patients with Fanconi Anemia from a quaternary referral center between 2007-2021 was completed for head and neck cancer risk. One hundred and five FA patients were reviewed. Average age at presentation was 11.3 years old and 90.5% of patients underwent hematopoietic stem cell transplant (HSCT). A total of 8.6% of patients had leukoplakia or erythroplakia and 3.8% developed malignancy. The standardized incidence ratio of head and neck malignancy was 483.8. Patients presented with leukoplakia and malignancy at an average age of 14.6 and 25.1 years old, respectively. Malignancies were aggressive and marked by recurrence. There were no premalignant or malignant lesions found on flexible laryngoscopy. This series represents the largest longitudinal series of pediatric FA head and neck lesions. Fanconi Anemia patients should begin screening for head and neck cancer at age 10 or after HSCT. Level 4 Laryngoscope, 133:1745-1748, 2023.

Do the Number, Size, and Position of Partially Threaded Screws Affect the Radiological Healing of Surgically Treated Displaced Femoral Neck Fractures? A Review of 136 Children.

Background and Objectives: The quantity, size, and position of implants might affect the fracture healing process of surgically treated displaced pediatric femoral neck fractures (PFNFs). The aim of this retrospective multicenter study was to evaluate the correlation between the time needed to achieve radiological union and the number, size, and location of the partially threaded cannulated screws (PTCSs) in children with displaced PFNFs. Materials and Methods: A retrospective review of 136 children (mean age: 10.6 ± 3.8 years) with displaced PFNFs treated by two (n = 103) or three (n = 33) PTCSs was carried out. Student’s t-tests, one-way ANOVA, Cox regression analysis, and multiple linear regression analyses were performed to investigate the variables affecting the time needed to achieve radiological fracture healing according to the number, size, and position of PTCSs, as assessed on plain radiographs. Results: A total of 132 hips achieved union at an average of 3.2 ± 1.6 months after the initial surgery. The time needed to achieve union in the patients treated with two or three PTCSs was comparable (p = 0.36). Among the fractures treated by two PTCSs, the time needed to achieve union did not correlate with the size of the implant (p = 0.122), or with the angulation between the PTCSs on anterior–posterior (p = 0.257) and lateral radiographs (p = 0.547). The time needed to achieve union in the fractures that were fully compressed by the implants was similar to the partially compressed fractures (p = 0.08). Conclusions: The number, size, and position of the PTCSs do not affect the radiological healing in the children with displaced PFNFs treated surgically.

Massive ganglioneuroma of the parapharyngeal space in a pediatric patient: a case report

BackgroundNeuroblastic tumors arise from primitive sympathetic ganglion cells and are the most common extracranial solid tumor of childhood. Ganglioneuroma is the most well-differentiated, benign subtype and comprises less than 1% of all soft tissue tumors. One to 5% of these occur in the head and neck, including the parapharyngeal space. It is uncommon to find a physically detectable, neoplastic parapharyngeal space mass in a child.Case reportA 7-year-old boy presented with a painless left neck mass. Imaging revealed a 2.6 × 2.7 × 6.1 cm left parapharyngeal space mass. Fine-needle aspiration suggested a ganglioneuroma. The patient developed compressive symptoms, notably pain, thus the decision was made to surgically resect. The tumor was excised transcervically, preserving the great vessels, phrenic and cranial nerves. Postoperatively, the patient developed a mild ipsilateral Horner’s syndrome, suggesting the mass to be a ganglioneuroma of the sympathetic chain.ConclusionsCervical ganglioneuromas typically present as slow-growing masses that cause compressive symptoms or are found incidentally. Resection is reserved for those with significant symptoms and is often complicated by Horner’s syndrome. In the review of literature, there are 23 reported cases of ganglioneuroma in the head/neck with a median age of 17 years. Eight of these occurred in the para/retropharyngeal spaces. Of these, five presented as an asymptomatic neck mass, two presented with compressive symptoms, and one was discovered incidentally. It is important to consider ganglioneuroma in the workup of pediatric neck masses, even in young children. Asymptomatic masses should be monitored for symptomatic transformation, and excision should be considered.