Congenital swellings of the head and neck

When faced with an infant or child presenting with any form of head and neck abnormality it is easy to be taken aback especially when one is more accustomed to seeing the adult population. There are perhaps three important rules to remember when seeing children with head and neck pathology. 1) The history is the most important part of the consultation. This is a throw back to our medical school days, but nevertheless especially appropriate within the paediatric population. 2) Common things are common and so neck lymphadenopathy from recurrent upper respiratory tract infections is the norm. 3) Rare pathology in the head and neck may be congenital and thus an intimate understanding and appreciation of embryological development of the head and neck is paramount.One factor that underpins all of the principles above is the fact that children generally present with different pathology compared to adults. Take for example a 5-year-old child presenting with a neck lump, and compare that with a 55-year-old man with the same lump. When stripped down to the bare bones, the ultimate aim is to exclude malignancy (often lymphoma) in the child, but to confirm a suspicion of malignancy in the adult.