Pediatric Head and Neck Tumors

The most common pediatric head and neck tumors occur in the thyroid — a butterfly-shaped gland in the neck. The thyroid is responsible for producing hormones that are important for your child’s growth and metabolism — the process by which the body converts food and drink into energy. A thyroid nodule is a lump that forms within the thyroid gland. It can be solid or filled with fluid (cystic); not all thyroid nodules in children require surgery.

Childhood thyroid cancer is relatively rare. More than 75% of thyroid nodules that occur in children and adolescents are benign. However, about 20 to 25% of thyroid nodules are malignant and require prompt treatment to achieve the best possible outcome. While childhood thyroid cancer can occur at any age, it tends to appear most often in the teenage years. In fact, thyroid cancer is the second most common cancer among adolescents ages 15 to 19.

A branchial cleft anomaly is a cluster of abnormal tissue that forms in a child’s neck. It happens in the early stages of an embryo’s development when the neck and throat tissues do not grow properly and form abnormal pockets and pathways. There are two types of branchial cleft anomalies: cysts, sinuses or pits (deep tissue pockets that fill with fluid) and fistulas (passages that drain from internal tissues to an opening on the skin’s surface).

Sometimes a branchial cleft anomaly is found when your baby is born, but it may not be detected until your child is older. Most are small, but they can grow large enough to cause your child difficulty with swallowing or breathing. They can also become infected, and these infections can keep coming back.

Branchial cleft and other neck anomalies are typically found during a physical exam. Your doctor may request additional diagnostic tests, including an ultrasound, CT or biopsy, to better understand your child’s specific anomaly. Treatment will depend on your child’s age and condition. Antibiotics are typically prescribed to address infection. Surgery may be needed to remove the affected tissue and prevent additional infections from occurring.

AdventHealth for Children’s Pediatric Head and Neck Surgery team cares for a full range of branchial cleft and other neck anomalies, including:

• Dermoid cysts
• Giant congenital melanocytic nevi
• Pilomatrixoma
• Preauricular pits
• Pyogenic granuloma (PG)

Craniofacial tumors occur in the bones of a child’s head and face, and most are benign. These abnormal growths are different from tumors that occur in adults, and they require a multidisciplinary care team with specialized knowledge, skills and experience to achieve the best possible outcome for your child.

The craniofacial area is the command center for so many essential daily functions — breathing, eating, tasting, smelling, seeing, hearing, speaking, thinking, feeling and communicating. All these things happen in a very small space, and in children, this area is still growing and developing.

Most benign craniofacial bone tumors in children cause problems by growing and pressing on structures within your child’s head or face as well as by disrupting their normal growth patterns. In fact, even a small tumor in a tight area can cause loss of function. Some of these tumors also have the potential to become cancerous over time, so early diagnosis and treatment is important.

At AdventHealth for Children, our multidisciplinary Pediatric Head and Neck Surgery team specializes in diagnosing and treating benign and malignant pediatric craniofacial tumors and closely collaborates to develop personalized treatment plans for even the most complex conditions, including the following:

• Benign
  Aneurysmal bone cyst
  Cherubism
  Fibrous dysplasia
  Giant cell tumor
  Juvenile nasopharyngeal angiofibroma
  Juvenile ossifying fibroma
  Langerhans cell histiocytosis
  
• Malignant
  Adamantinoma
  Ameloblastic carcinoma
  Chondrosarcoma
  Chordoma
  Ewing sarcoma
  Malignant fibrous histiocytoma
  Odontogenic carcinoma
  Osteosarcoma

Odontogenic tumors occur in the bones of the jaw as well as in the tissues that form teeth. They are often first discovered by a child’s dentist during routine X-rays. While most odontogenic bone tumors are benign, some can become malignant. In children, these tumors can cause jaw issues and prevent new teeth from properly developing. Surgery is typically required to remove the tumor. Sometimes, several different staged surgeries or advanced reconstruction procedures are required over the course of several years to ensure a child’s teeth and jaw function properly as they grow.

AdventHealth for Children’s Pediatric Head and Neck Tumor Program provides specialized, multidisciplinary care for a full range of pediatric odontogenic bone tumors, including even the most complex cases:

• Ameloblastoma
• Keratocystic odontogenic tumor (KOT)
• Odontoma
• Cementoma

A cyst is a sac filled with fluid or tissue that can form in any part of the body. There are many different types of cysts that can form in a child’s head or neck, and they are typically classified as odontogenic or nonodontogenic. Our specialized surgical team is experienced in treating both common and rare odontogenic and nonodontogenic cysts that can occur in children.

Odontogenic cysts are more common in children and begin in a tooth or in its supporting tissue. They’re often detected during routine examinations, dental X-rays or orthodontic workups, and left untreated, can potentially interfere with proper growth and development of a child’s teeth and jaw.

Nonodontogenic cysts can form in any other non-tooth-forming tissue. If your child has either of these types of cysts, they may require surgery to remove it.

A neurogenic tumor starts in cells within the nervous system. In children, they most commonly occur in the mediastinum — the area between the lungs. However, neurogenic tumors can also occur in the head and neck region. Pediatric neurogenic tumors are typically diagnosed using ultrasound, CT, MRI, or fine needle aspiration biopsy. Most are benign, but some can be malignant.

The most common malignant (cancerous) neurogenic tumor to occur in children is called neuroblastoma, and it develops in the nerve tissue of infants and very young children, sometimes before the child is even born. The cancer cells usually begin in the adrenal gland found in the abdomen but can also develop in nerve tissue located in a child’s head or neck. This type of cancer can quickly spread to other areas of the body, so early detection is critical to achieving the best possible outcome.

Types of primary neurogenic tumors:

• Carotid body tumor (CBT)
• Glomangioma
• Malignant peripheral nerve sheath tumor
• Neuroblastoma
• Paraganglioma (PGL)
• Sarcoma
• Schwannoma

Vascular anomalies (malformations) are birthmarks or growths made up of blood vessels — capillaries, veins, arteries, lymphatic vessels or any combination of these — that have not properly developed. Many are present at birth, but some do not appear until a child is older. Although they’re relatively common, these abnormal growths can affect your child’s appearance, health and daily function.

Some vascular anomalies are quite complex. That is why children with vascular anomalies should be evaluated and treated by an experienced, specialized medical team like the one at AdventHealth for Children. We provide comprehensive, coordinated, interdisciplinary care for all types of vascular anomalies that occur in children, including the following:

• Arteriovenous malformations (AVM) — abnormal arteries and veins
• Capillary malformations — abnormal capillaries (also called port-wine stains)
• Lymphatic malformations — abnormal lymph vessels that can cause swelling and enlarged cysts

Venous malformations — abnormal veins

The salivary glands are located on each side of the face and are responsible for making saliva to lubricate the mouth and throat. These glands also produce enzymes that help begin the process of digesting food, as well as antibodies that can help prevent infection. Abnormal growths (anomalies) and tumors can develop in a child’s salivary glands. In adult patients, most are benign, and few are malignant. But in children, these tumors are more often malignant.

One of the greatest risk factors for the development of a salivary gland tumor in children is previous treatment for leukemia or another solid cancerous tumor. This includes radiation therapy to the neck or whole body, as well as chemotherapy. The most common symptom of a pediatric salivary gland tumor is a lump near the cheek, ear, jaw, or lip, or inside the mouth as well as weakness, numbness or pain in the face.

Treatment of a salivary gland tumor typically begins with surgery to remove the growth and any affected surrounding tissue. If the tumor is located in the parotid gland (the salivary glands located in front of the ears), precise surgical planning and special neurological monitoring during the surgery is necessary to protect your child’s facial nerve. Depending on the size, stage and complexity of your child’s specific tumor, radiation therapy or targeted therapy may also be needed to fully treat the cancer.

AdventHealth for Children’s Pediatric Head and Neck Program is experienced in caring for even the most complex and rare salivary gland anomalies and tumors, including:

• Acinic cell carcinoma
• Adenoid cystic carcinoma
• Mucoepidermoid carcinoma (MEC)
• NUT carcinoma
• Pleomorphic adenoma
• Ranula