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When Head and Neck Masses are Alarming

October 09, 2009
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Pediatric otolaryngologist Emily Rudnick with a young patient.


Because of their exposure to other kids and their still-developing immune systems, children can be particularly vulnerable to head and neck masses, especially enlarged lymph nodes caused by inflammation, viruses or infections. These lesions usually are not dangerous and can be treated with medication or may go away on their own.

"But when they persist or are associated with other signs and symptoms, the concern is whether it could be something more ominous," says David Tunkel, director of pediatric otolaryngology . "Even though these masses tend to be of limited consequence, there’s that rare bird who has symptoms requiring a more specific and urgent evaluation," including a biopsy.

The tricky part of diagnosing and treating pediatric head and neck masses is often distinguishing the cases that are more serious. When the worst happens, Tunkel says, and a growth turns out to be a malignant tumor, is obstructing the airway or is causing severe disfigurement or lost function, the patient’s best bet is a physician who sees similar cases on a regular basis. Hopkins two newest pediatric otolaryngologists, Margaret Skinner and Emily Rudnick, came here specifically because of their special interests in treating head and neck masses. Skinner focuses on congenital anomalies and tumors of the head and neck, and Rudnick hemangiomas and vascular malformations, including capillary, venous and lymphatic malformations.

"Even if these masses are benign," explains Rudnick, "they can significantly affect a child’s function and cause chronic problems."

But because these tumors and masses present in so many different forms, it’s unlikely that any one physician would regularly see and treat each type. That’s why the department relies on a five-person team of pediatric otolaryngologists with training and experience in the full spectrum of head and neck masses, as well as a vascular anomaly panel – a multidisciplinary team assembled specifically for treating certain head and neck masses.

"These lesions can have tremendous social, emotional and physical consequences for the child and family," says Rudnick. "Treating the patient in a team environment is critical in getting the most thorough care and the best results for the patient."

For more information or patient referrals, call 410-955-9772.