Observation-Only Management of Cervicofacial Nontuberculous Mycobacterial Lymphadenitis in Children

To determine the natural history of nontuberculous mycobacterial (NTM) lymphadenitis in immunocompetent children managed nonoperatively.

A retrospective study including patients (< 18 years old) diagnosed with cervicofacial NTM lymphadenitis at a tertiary children's hospital between 2017 and 2023. Patients were either observed or surgically treated. Analysis focused on observation outcomes. Surgical patients were included for comparative context.

Seventy-two patients were included; 45 (63%) were managed by observation-only and 27 (37%) underwent surgical excision. Baseline characteristics were similar between groups. Median follow-up was longer in the observation group (123 days [IQR: 92-264]) than in the surgical group (83 days [IQR: 60-98], p < 0.001). Among observed patients, median time to resolution was 168.5 days (IQR: 97-291). Kaplan-Meier-estimated cumulative resolution was 26.3% at 4 months, 42.7% at 6 months, and 82.8% at 12 months. Older age predicted faster resolution (HR: 1.22, 95% CI: 1.04-1.42, p = 0.01), while parotid involvement predicted slower resolution (HR: 0.21, 95% CI: 0.06-0.72, p = 0.01). One patient in the observation group developed a keloid requiring scar revision. In the surgical group, three patients (11%) experienced marginal mandibular nerve weakness.

Observation-only management of cervicofacial NTM lymphadenitis in children resulted in high rates of spontaneous resolution by 12 months with minimal morbidity. While surgical excision provided faster resolution, it carried a higher risk of facial nerve injury. Observation may be a safe, effective alternative for selected patients, potentially avoiding surgical complications.