Pediatric neck masses are relatively common in pediatric otolaryngology and head and neck surgery, with congenital neck masses being the most common, mainly cystic masses formed by congenital dysplasia, including thyroglossal cysts, parotid cysts, dermatomal cysts, and epidermoid cysts. They also include teratomas, malformations, ectopic thyroid and vascular tumors such as lymphadenoma and hemangioma. In addition to congenital masses, some of the pediatric neck masses are malignant tumors such as thyroid cancer, rhabdomyosarcoma, and lymphoma. Different conditions have different treatment plans and different treatments will bring different prognosis. Pediatric neck masses should be detected early, diagnosed early, and treated regularly and reasonably. The following is a description of several common childhood neck masses: 1. Cheek cleft cysts and fistulas: Depending on the type of cheek cleft cysts and fistulas. Generally, the first cheek cleft cyst and fistula are located near the angle of the mandible or the lower posterior part of the earlobe, and their accompanying fistula inlets are mostly located in the external auditory canal. The second cheek cleft cyst is usually located to the left or right of the anterior neck, and if accompanied by a fistula, the fistula is located in the tonsillar fossa. The third cheek cleft cyst and fistula are similar in location to the second cleft cyst and fistula, except that the fistula has a different internal shape. The fourth cleft cyst and fistula are extremely rare, and the external opening of the cyst and fistula is also located on the anterior side of the neck, and the fistula can travel down into the thoracic cavity. Symptoms: There are three most common clinical signs of cheek cleft cysts and fistulas: fast neck pack, neck fistula discharge, and recurrent infections. In general, parents inadvertently find a mass in the neck of the child, mostly with small eyes on the skin, intermittent and repeated discharge, local redness, swelling and pain when infected, sometimes with fever, which can improve after anti-infective treatment, but is prone to recurrence. Signs: Soft masses can be palpated on the left or right side of the anterior neck of the child, which can be accompanied by skin fistulae. Ancillary examinations: Enhanced CT examination of the neck and ultrasound examination of the neck may be given to understand the nature and extent of the mass. Treatment: Generally, surgery should be performed as soon as possible after diagnosis. If infection is present, surgery should be performed after controlling the infection. Surgery is performed under general anesthesia, and the mass is usually discharged after 2-3 days of postoperative observation if no infection has occurred, or 2 weeks if infection or pharyngeal fistula has occurred. The average length of stay is 1-2 weeks. Outpatient follow-up is required for all postoperative cases. 2. Thyroglossal cyst and fistula: one of the more common congenital malformations of the pediatric neck, most often seen in children 1-10 years old, and asymptomatic individuals can be diagnosed only in middle age and old age. The incidence of cysts is higher than the incidence of fistulas. Signs: the mass is located in the subcutaneous or anterior mid-neck, and when there is no infection, it is smooth, with clear borders, usually 2-4 cm in diameter, and can move up and down with swallowing. There is generally no special discomfort, but a few cases with infection have local pain. The mass may increase significantly in the short term and attract parents’ attention. The infected cyst may form a local fistula if it ruptures. In thyroglossal fistula, the fistula is located on the anterior midline of the neck, and there is much recurrent discharge. Ancillary tests: Ultrasound of the neck and enhanced CT of the neck can assist in the diagnosis. Treatment: Surgery should generally be performed as soon as possible after the diagnosis is confirmed. If there is infection, surgery should be performed after controlling the infection. Surgery is performed under general anesthesia, and the mass is usually discharged after 1-2 days of postoperative observation if no infection has occurred, or 1-2 weeks if infection or pharyngeal fistula has occurred. The average length of stay in the hospital is 1-2 weeks. Postoperative outpatient follow-up is required for all patients. Those who have undergone thyroglossal cyst and fistula surgery and have recurrence after surgery can also undergo reoperation at an optional date. 3. Head and neck lymphangiectasia: Most of them appear after birth, and 90% of them occur before 2 years old. It is a congenital disease of lymphatic tissue. Signs: Most of them are located in the posterior region of the neck, but they can also go up to the cheek and parotid area, and down to the axilla and chest when they are larger. Asymptomatic lymphomas are not easily detected, and some parents seek medical advice because of asymmetry between the left and right side of the child’s face. Larger lymphangioleiomas may cause airway obstruction and facial disfigurement. The lump is soft and elastic with unclear borders, and the cystic feeling is obvious in single cysts. If trauma or puncture causes intracapsular hemorrhage, the mass will increase rapidly in a short period of time. Ancillary tests: Ultrasound of the neck and enhanced CT of the neck can assist in the diagnosis. Treatment: Once the diagnosis is confirmed, active treatment should be given. The treatment plan is designed according to the age of the child and the size and location of the mass, monocystic or multicystic rows. Treatment options include surgical excision, puncture and aspiration + local drug injection therapy, surgical excision + local drug injection therapy. Generally, drug injection therapy alone can be performed under general anesthesia or local anesthesia with a hospital stay of 2-3 days. Surgical treatment and surgical + drug injection treatment need to be performed under general anesthesia, and the number of hospital days is 1-2 weeks. Regular postoperative follow-ups are required on an outpatient basis and may be combined with multiple drug injections depending on the situation. Most patients are treated satisfactorily. There are many different types of head and neck masses, with different clinical manifestations and treatments, so the treatment should be individualized for the child, and specific analysis is needed for each problem.