[Cystic lymphangioma in the head and neck region]

Cystic lymphangioma or hygroma (CL) is a rare benign pathology of the lymphatic system characterized by multiple cystic, often non-communicating concamerations. Such lesions are most often seen in infancy and in 80% of the cases they appear within the first two years of life. They arise most commonly in the neck. CL usually tends to grow slowly and rarely regresses spontaneously. Infection and/or hemorrhage can lead to a rapid increase in size, possibly obstructing the initial portion of the upper aero-digestive tract. In the present study four patients (age range 12 months to 21 years) with head and neck CL, two with parotid primary site, were observed and treated by surgery. The lesions were studied using such imaging techniques as the color Doppler, CT and NMR. The latter permitted accurate pre-operative staging which is essential to defining and "mapping" the individual cystic concamerations. Surgery gave good results in 3 cases while in one case of multiple recurrences repeated post-operative sclerotherapy proved necessary leading to a partial reduction in the lesion. Despite the fact that numerous therapeutic options have been presented over the years, most authors today agree that the treatment of choice in cases of CL is surgery. Preparation for surgery must include accurate study with NMR, an indispensable technique for such pathologies as the T2 weighted sequences give very precise mapping. Surgical exeresis should be selective for the lesion while preserving the adjacent vascular-nervous structures.