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may precipitate a rapid change in ICP followed by herniation of the brain. The
pressure may be relieved using steroids such as dexamethasone at a dose of 2 to 4
mg every 6 hours. Mannitol or hypertonic (3%) saline may be useful in decreasing
ICP. In some situations, intubation may be needed for both airway protection and to
allow for hyperventilation to lower PCO 2 when signs of herniation are present.
Neurosurgical consultation can address the appropriateness of a ventriculostomy or
debulking procedure. The decision about where to admit a patient with a newly
diagnosed brain tumor hinges primarily on the neurologic status. Patients may have
altered airway, breathing, or circulation due to the tumor compressing the brainstem.
Cranial nerve dysfunction may compromise a patient’s ability to eat normally. The
tumor may cause symptoms such as headache, nausea, or vomiting, which require
inpatient management. Functional deficits may make discharge problematic. In any
of these cases, patients should be admitted to the hospital with prompt consultation
with pediatric oncology, pediatric neurology, and pediatric neurosurgery for
definitive management.

TUMORS OF THE HEAD AND NECK
Goals of Treatment
Children with head and neck tumors should be rapidly assessed for airway
impingement, breathing compromise, and cervical spinal cord compression.
CLINICAL PEARL AND PITFALLS
Cervical lymphadenopathy is common in childhood and rarely due to
cancer. Characteristics that make malignancy more likely include
nontender masses, very firm/hard texture, diameter more than 3 cm,
adherence to other structures, irregular margins, and absence of signs or
symptoms of infection.
Retinoblastoma often presents with leukocoria (white pupil) first noticed
by parents.

Current Evidence
Head and neck tumors represent a diverse range of conditions and, with the

exception of retinoblastoma and neuroblastoma, occur most commonly in older
children and teenagers. Aerodigestive tract malignancies include sarcomas,
lymphoid tumors, and carcinomas. While the latter are commonly seen in the adult
population, carcinoma is rare in pediatrics.

Clinical Considerations