Spectrum and Surgical Management of Pediatric Neck Swellings: A Retrospective Study from Libya

Abstract

Neck swellings are a common reason for referral to pediatric surgical services, but the underlying diagnoses vary across populations, and published evidence from Libya is scarce. We conducted a retrospective descriptive study of children who underwent surgery for a neck swelling in the Department of Pediatric Surgery at Misurata Medical Center, Libya, between January 2022 and March 2026, using the departmental register, operation register, operative logbook and histopathology reports. Sixty-six children were included (35 female, 31 male; median age 3.0 years, IQR 1.2–7.0; range 6 days–13 years). Neck abscess was the most common diagnosis (23; 34.8%), followed by thyroglossal duct cyst/sinus (19; 28.8%), branchial cleft anomalies (7; 10.6%), and lymphadenopathy requiring surgery (5; 7.6%). Congenital lesions accounted for 50.0% and inflammatory lesions for 42.4%. One 12-year-old boy with a supraclavicular swelling had a sarcomatous lesion (1.5%). Children with inflammatory lesions were younger than those with congenital lesions (median 2.0 vs 5.0 years; p = 0.002), and abscesses presented earlier than thyroglossal duct cysts (median 1.6 vs 6.0 years; p < 0.001). Histopathology was available for 16 patients (24.2%), and the clinical diagnosis was confirmed in all 14 cases with a specific preoperative diagnosis. Most surgically managed pediatric neck swellings were benign. Abscesses predominated in infants and toddlers, whereas thyroglossal duct cysts predominated among school-age children. The single malignant case presented as a supraclavicular mass, reinforcing the importance of this warning sign. Incomplete paper-based records support the need for a structured departmental registry and more consistent histopathological submission