Cervicofacial lymphadenitis caused by nontuberculous mycobacteria (NTM) is an increasingly recognized condition in otherwise healthy children, most commonly between 1 and 5 years of age. It typically presents as a firm, painless cervical, submandibular, or parotid mass that slowly enlarges over weeks, with progressive thinning and violaceous discoloration of the overlying skin and, in advanced stages, spontaneous fistulization. Although NTM lymphadenitis remains rare in absolute terms, several population-based series suggest a rising incidence, including data from Québec indicating a marked increase in hospital-based diagnoses over recent decades. This trend underscores the need to refine management strategies that balance cure, complication risk, and long-term cosmetic outcomes.

Definitive diagnosis relies on microbiologic confirmation by PCR or culture, but clinicians frequently rely on a combination of clinical presentation, tuberculin skin testing, interferon-gamma release assays, and imaging to guide initial management. Available therapeutic options include observation, systemic antibiotic therapy, non-excisional procedures (fine-needle aspiration, incision and drainage, curettage), and complete or partial surgical excision. Current literature generally supports complete excision of affected lymph nodes as the modality with the highest cure and lowest recurrence rates, with reported success exceeding 95%, compared with lower cure rates for antibiotics alone, observation, or non-excisional interventions. However, complete excision may require extensive dissection in anatomically sensitive regions, exposing children to risks such as facial nerve palsy, wound infection, conspicuous or widening scars, and contour deformities—particularly concerning in young children with elastic skin and a long lifetime of scar maturation ahead.

Emerging data suggest that partial excision can achieve comparable clinical resolution in some patients, raising a critical question: are the peripheral lymph nodes and surrounding tissues routinely removed during “complete” excision truly involved by active NTM infection at histopathology, or does an intact immune system clear residual disease without the need for maximal surgery? To date, this specific question has not been systematically examined.

This presentation will synthesize current evidence on the epidemiology, diagnostic pathways, and comparative effectiveness of medical and surgical management for pediatric cervicofacial NTM lymphadenitis. It will then introduce an ongoing project that correlates the histopathologic status (microabscesses, caseating and non-caseating granulomas) of peripheral tissues with clinical outcomes following partial versus more extensive excision. By highlighting this knowledge gap, the proposal aims to stimulate discussion on whether a de-escalation of surgery—tailored to disease extent—could maintain high cure rates while reducing complications and improving cosmetic results.