Multimodality treatment of pediatric lymphatic malformations of the head and neck using surgery and sclerotherapy
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Published on: March 18, 2020
Simone J Boardman1, Lesley A Cochrane, Derek Roebuck
1Departments of Paediatric Otolaryngology, Great Ormond Street Hospital for Children, London, England. simoneboardman@hotmail.com
Insights
Multimodality treatment for pediatric head and neck lymphatic malformations, including surgery and sclerotherapy, shows good outcomes, especially for isolated neck disease. Treatment is individualized based on location and classification.
Area of Science:
- Pediatric Otolaryngology
- Head and Neck Surgery
- Vascular Anomalies
Background:
- Lymphatic malformations (LMs) are congenital vascular anomalies affecting the head and neck in children.
- Management of pediatric head and neck LMs presents unique challenges due to anatomical complexity and potential for functional impairment.
Purpose of the Study:
- To evaluate a multimodality treatment approach for pediatric head and neck lymphatic malformations.
- To compare outcomes of surgery, sclerotherapy, and combined modalities for managing these lesions.
Main Methods:
- Retrospective case series of 97 pediatric patients (1 month–16 years) treated over 7 years.
- Treatment modalities included surgery (excision, laser) and sclerotherapy (OK-432, Ethibloc), or both.
- Clinical and MRI assessments guided individualized, problem-based treatment decisions.
Main Results:
- Complete or near-complete responses were observed in all isolated neck LMs, with no nerve palsies.
- LMs involving the parotid, laryngopharyngeal, or oral regions had poorer outcomes and required multiple treatments.
- Significant long-term neural injury occurred in 3/6 surgical patients with mediastinal LMs, and in 4% of other surgical procedures.
Conclusions:
- Surgery remains crucial for pediatric head and neck LMs, complementing sclerotherapy.
- Isolated neck LMs demonstrate excellent outcomes with either surgical or sclerotherapy treatment.
- Individualized, anatomical, and classification-based treatment selection optimizes management of pediatric head and neck LMs.
Objectives:
To describe a multimodality approach to the management of pediatric head and neck lymphatic malformations using surgery, sclerotherapy, or both and to review the outcomes of these approaches.
Design:
Retrospective case series.
Setting:
A single pediatric tertiary care referral center.
Patients:
Ninety-seven pediatric patients (aged 1 month to 16 years) diagnosed as having lymphatic malformations of the head and neck during a 7-year period. Follow-up ranged from 3 months to 7 years.
Interventions:
All of the patients underwent clinical and radiologic (magnetic resonance imaging) assessment. Treatment modality was selected according to disease location, cyst size, and parental preference. Treatments included surgery (open excision, tongue reduction, electrocautery, and laser treatment), sclerotherapy with OK-432 (Picibanil) or a fibrosing agent (Ethibloc), and a combination of modalities.
Main Outcome Measures:
Clinically determined responses to treatment, complications, and number of treatments required.
Results:
All isolated neck disease had complete or near-complete responses, with no nerve palsies sustained. Although most patients achieved complete or near-complete responses, disease with parotid, laryngopharyngeal, or oral components had poorer outcomes and frequently required multiple treatments. Significant long-term neural injury was sustained in 3 of 6 surgical patients for mediastinal disease and in only 4% (n = 4) of other surgical procedures.
Conclusions:
Surgery retains an important role in the treatment of pediatric head and neck lymphatic malformations despite the advent of sclerotherapy. Isolated neck disease has an excellent outcome with either modality. Treatment decisions were made via a problem-based approach and were individualized according to anatomical location and disease classification.
