Parotitis is most commonly viral, and treatment involves supportive care including citric or sour food to facilitate salivary flow Avoid incision and drainage of facial abscesses near the ramus of the mandible, as they may represent an infected first branchial cleft remnant When torticollis is associated with a neck mass in infants, sternocleidomastoid tumor (fibromatosis colli) should be considered Posterior triangle and supraclavicular masses carry a much higher risk for neoplasm than anterior triangle masses Consider treatment for MRSA in acute lymphadenitis if the infection is not improving after treatment or in regions of high prevalence Consider an evaluation for pyriform sinus fistulas in children with acute suppurative thyroiditis Neck lesions in children may be of congenital origin or may be acquired as the result of an inflammatory process ( Fig 120.8 ) Although malignancy is a rare cause of neck masses in children, it must always be considered in the differential diagnosis Neck masses or lesions are most conveniently divided into those occurring in the midline and those located in the lateral aspects of the neck (see Chapters 48 Neck Mass and 118 ENT Emergencies ) Midline Neck Lesions Submental lymphadenitis or lymphadenopathy occurs in the midline just beneath the chin Nodal enlargement stems from drainage of a primary infection of the lower lip, buccal floor, or anterior tongue Management should be directed at treating the primary infection and if antibiotics are indicated should cover for oral anaerobes Dermoid cysts (see “Face and Scalp Lesions” section) can occur throughout the midline of the neck but are usually found above the area of the hyoid They may also be found more laterally along the anterior border of the sternocleidomastoid