treatment Facial and cranial asymmetry can develop without intervention Surgical intervention is rarely needed Inflammatory Masses Cervical lymphadenopathy is the most common cause of neck masses in children Examination of children 12 years of age and younger may reveal palpable cervical lymph nodes measuring up to cm (1.5 cm if in the jugulodigastric chain) Children between the ages of and years can present with self-limited episodes of lymphadenopathy measuring up to to cm, approximately 90% of which may be idiopathic Lymphadenopathy in newborns and young infants is rare, however, and warrants investigation Potential etiologies for cervical lymphadenopathy include local, regional, or systemic illness in addition to viral or bacterial infections Anterior cervical nodes drain the oropharynx and become enlarged after URIs, oral, and pharyngeal infections Inflammation or infection of the scalp, and nasopharynx cause enlargement of posterior cervical nodes Conversely, supraclavicular lymphadenopathy is considered pathologic and warrants further investigation Though chronicity of findings is variable depending on etiology (e.g., rhinovirus, parainfluenza virus, respiratory syncytial virus [RSV], Cytomegalovirus, and Epstein–Barr virus [EBV]), adenopathy secondary to viral infections is self-resolving Lymphadenopathy from an underlying bacterial cause should resolve with appropriate antibiotic therapy Supraclavicular nodes should be referred to specialist for biopsy Cervical lymphadenitis represents an acute infection present within one or multiple nodes, frequently in the context of a recent URI, pharyngitis, tonsillitis, or otitis media (see Chapters 94 Infectious Disease Emergencies and 118 ENT Emergencies ) This manifests as enlargement, erythema, warmth, and tenderness of the involved lymph nodes Systemic symptoms of fever and malaise may be present Without antibiotic treatment, infection may progress with nodal enlargement, suppuration, and regional cellulitis Common bacterial causes include group A β-hemolytic streptococcus (GAS), Haemophilus influenzae, and anaerobic bacteria Most milder cases resolve with warm compresses and oral β-lactamase–resistant antibiotics The incidence of Staphylococcus aureus infection (possibly methicillin resistant), is on the rise, however While clindamycin is generally effective against methicillin-resistant S aureus, knowledge of local resistance patterns is important when selecting antibiotic coverage Failure of outpatient management warrants further diagnostic investigation, which may include serologies, ultrasound, fine needle aspiration, and incision and drainage Purulent fluid should be sent for Gram stain and aerobic and anaerobic cultures to guide antibiotic management For toxic and ill-