A 15-year-old with a Slowly Enlarging Submental Mass

1. Emily E. Wikner, BA* 2. Collin F. Mulcahy, MD†,‡ 3. Lyuba Gitman, MD‡ 4. Pamela A. Mudd, MD, MBA‡ 1. *School of Medicine and Health Sciences, 2. †Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, George Washington University, Washington, DC 3. ‡Department of Pediatric Otolaryngology, Children’s National Medical Center, Washington, DC A 15-year-old otherwise healthy boy presents to plastic surgery clinic with a 1-year history of a painless, but enlarging submental neck mass. He denies pain, odynophagia, dysphagia, or change in size or movement of the mass while eating. The patient undergoes a neck and thyroid ultrasound, which reveals a heterogeneous soft tissue focus in the submental triangle (level 1A of the neck), as well as unusual hypoechoic, elongated tissue situated posterior to the left lobe of the thyroid of unclear etiology. The patient then presents to the Pediatric Otolaryngologic clinic at our institution. Physical examination reveals a firm, nontender, 3-cm submental mass without any other palpable lymphadenopathy. His trachea is midline, he has full neck range of motion, and there are no visible or palpable abnormalities of his thyroid gland. Additionally, the patient’s floor of mouth is soft to palpation without any evidence of mass or abnormality. A computed tomography scan soft tissue neck with contrast is obtained (Fig 1), which reveals a left submental soft tissue mass that was well-circumscribed, isodense, measuring 2.7 × 1.5 × 1.9 cm. There is no extension or invasion into adjacent structures, and there are no abnormalities in the retro-esophageal area, or thyroid lesions or abnormalities. Figure 1. (Left) Axial slice of computed tomography (CT) scan soft tissue neck with contrast demonstrating a well-circumscribed lesion …