Observation‐Only Management of Cervicofacial Nontuberculous Mycobacterial Lymphadenitis in Children

ABSTRACT Objectives To determine the natural history of nontuberculous mycobacterial (NTM) lymphadenitis in immunocompetent children managed nonoperatively. Methods 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. Results 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. Conclusions 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. Level of Evidence 3.