J Korean Assoc Pediatr Surg.  2015 Dec;21(2):17-23. 10.13029/jkaps.2015.21.2.17.

Surgical Treatment of Difficult Cervicofacial Lymphangioma in Children

Affiliations
  • 1Division of Pediatric Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jm0815.seo@samsung.com
  • 2Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

PURPOSE
Cervical lymphangiomas are rare lymphovascular malformations arising in the neck, which form huge fluid-containing cysts. Treatment of the malformation consists of surgery and sclerotherapy. However, the optimal approach is still controversial. Here, we describe a series of cervical lymphangiomas which have been treated with surgical approaches.
METHODS
We retrospectively investigated the medical records of 82 patients who had been diagnosed with cervicofacial lymphangioma from 2001 to 2012 in our center. A closed suction drainage with negative pressure was placed on the operative lesion following excision to prevent reaccumulation of lymphatic fluid and the drainage tube was removed after injecting OK-432 through the tube.
RESULTS
Twelve patients underwent surgical excision of cervical lymphangioma. The median patient age was 3 months at the time of the operation. The patients have been followed-up over a period of 34 months. When lesions were located near vital organs such as the trachea or carotid artery or did not respond to repetitive OK-432 injections, surgical treatment might bring good outcomes. However, swallowing difficulty, lip palsy, or dyslalia due to adjacent nerve damage temporarily appeared as postoperative complications. Five children had tracheostomy due to tracheal or subglottic stenosis and 2 patients had gastrostomy due to aspiration while they eat after surgery.
CONCLUSION
Surgery for cervicofacial lymphangioma should be conducted carefully in selective cases. A well thought-out surgical plan with a multidisciplinary surgical team approach and placement of closed suction drainage tube after surgery and adjuvant OK-432 sclerotherapy through drainage tube seem to be helpful for good outcome.

Keyword

Cervical lymphangioma; Lymphatic malformation; OK-432 sclerotherapy; Excision; Suction drainage

MeSH Terms

Carotid Arteries
Child*
Constriction, Pathologic
Deglutition
Drainage
Gastrostomy
Humans
Lip
Lymphangioma*
Medical Records
Neck
Paralysis
Picibanil
Postoperative Complications
Retrospective Studies
Sclerotherapy
Speech Disorders
Suction
Trachea
Tracheostomy
Picibanil
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