Otolaryngology-Head & Neck Surgery

Teaming Up for Tiny Patients

Pediatric otolarynglogist Emily Rudnick Boss works with
an infant. Rudnick Boss is especially interested in
treating hemangiomas and vascular malformations.

A joint effort by experienced providers is crucial for curing head and neck masses.

Any growth appearing on the head or neck is alarming, and especially so when the patient is a child. But no matter how worrisome, these masses are fairly common, often benign and, in the hands of a skilled otolaryngologist, treatable.

Because of their exposure to other kids and their still-developing immune systems, children can be particularly vulnerable to head and neck masses, especially enlarged lymph nodes caused by inflammation, viruses or infections. These lesions usually are not dangerous and can be treated with medication or may go away on their own. “But when they persist or are associated with other signs and symptoms, the concern is whether it could be something more ominous,” says David Tunkel, director of pediatric otolaryngology. “Even though these masses tend to be of limited consequence, there’s that rare patient who has symptoms requiring a more specific and urgent evaluation,” including a biopsy. With those children in mind, he continues, the Department of Otolaryngology has added two new pediatric otolaryngologists who specialize in caring for children with head and neck masses.

The tricky part of diagnosing and treating pediatric head and neck masses is often distinguishing the cases that are more serious. When the worst happens, Tunkel says, and a growth turns out to be a malignant tumor, is obstructing the airway or is causing severe disfigurement or lost function, the patient’s best bet is a physician with specific training and expertise who sees similar cases on a regular basis. And ideally, that physician will have the full support of a multidisciplinary team like the one at Johns Hopkins.

The team’s two newest physicians, Margaret Skinner and Emily Rudnick Boss, came to Hopkins specifically because of their expertise in pediatric otolaryngology and their special interests in treating head and neck masses. Skinner, whose clinical interests include congenital anomalies and tumors of the head and neck, joined the department on Nov. 1, 2008. Rudnick is particularly interested in treating hemangiomas and vascular malformations, including capillary, venous and lymphatic malformations. Since joining the faculty in September, she has become involved in clinical trials and has been a regular participant in the department’s vascular anomaly panel, a multidisciplinary team assembled specifically for treating certain head and neck masses. “Even if these masses are benign,” explains Rudnick, “they can significantly affect a child’s function and cause chronic problems.”

Because these tumors and masses present in so many different forms, it’s unlikely that any one physician would regularly see and treat each type. Johns Hopkins, though, has a five-person team of pediatric otolaryngologists with combined training and experience in the full spectrum of head and neck masses.

“Treating patients in a team environment is critical in getting the best results for the patient,” Rudnick says. “These lesions can have tremendous social, emotional and physical consequences for the child and family. Providing interdisciplinary treatment allows the child to receive the most thorough care.”

To discuss a case or refer a patient call +1.443.287.6499.

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