Congenital head and neck masses in children are a diverse group of lesions. Thyroglossal duct abnormalities are the most common, followed by branchial apparatus abnormalities, lymphangiomas (cystic hygroma), and subcutaneous vascular abnormalities (hemangioma, AVM). It is important to note that cutaneous hemangiomas are not included in this discussion of congenital masses. If they are considered within the general topic of congenital head and neck masses, vascular lesions by far are the most common. Teratomas and dermoid cysts represent true congenital neoplasms and are relatively uncommon. Several rare lesions have been noted in the discussion and should be included in the differential diagnosis. The diagnosis of these particular masses depends largely on history and physical examination. The location of the mass itself greatly limits the differential diagnosis. Ancillary studies such as plain x-rays, ultrasound, CT scanning, and angiography are useful in further limiting the possible diagnoses. Subcutaneous hemangiomas, ectopic thyroid, congenital goiter, and fibromatosis colli can be treated medically or with simple observation. Surgery is reversed for enlarging lesions or lesions affecting vital structures. The remainder of the congenital head and neck masses generally require early excisions to avoid complications of infection, airway obstruction, nutritional compromise, or the risk of malignant transformation.