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Long-term outcome of radiofrequency ablation for intraoral microcystic lymphatic malformation
Sang W Kim1, Katie Kavanagh, Katie Kauvanough
1Department of Otolaryngology and Communication Enhancement, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
Objective:
To determine long-term outcome of radiofrequency (RF) ablation of microcystic lymphatic malformation (LM) of the oral cavity for control of recurrent infection and bleeding.
Design:
Institutional review board-approved retrospective study,
Setting:
Tertiary pediatric medical center,
Patients:
Twenty-six patients with intraoral microcystic LM were treated with RF ablation from August 2002 through August 2010.
Intervention:
Radiofrequency ablation of intraoral LM.
Main Outcome Measures:
Postoperative stay, diet, pain; control of bleeding and/or infection; recurrence; and indication for retreatment.
Results:
The most common complaints necessitating initial RF ablation were recurrent infection (n=10 [37%]) and bleeding (n=9 [33%]). The most common problems requiring further ablation were bleeding (n=11 [41%]) and cosmetic deformity not affecting function (n=8 [31%]). Fourteen patients (55%) were discharged home on postoperative day (POD) 3; the remaining 11 (45%) were discharged home on POD 4. Thirteen patients (52%) resumed oral diet immediately on the day of the procedure. Ten patients (38%) began eating on POD 1, and virtually every patient was on full oral intake at discharge. Fourteen patients (55%) required only acetaminophen for pain control, 11 (41%) required acetaminophen with codeine, and 1 (4%) required oxycodone. The mean follow-up time was 47 months after treatment. At the most recent clinic evaluation, 13 patients (50%) were symptom free, 8 (31%) were stable and improved without need for future treatment, and 5 (19%) required further treatment. One-half of patients in the study group underwent more than 1 RF procedure for recurrence. The number of RF ablations in this series were 1 procedure (n = 13), 2 procedures (n = 7), 3 procedures (n = 2), 4 procedures (n = 2), and 6 or 7 procedures (n = 2).
Conclusions:
Radiofrequency ablation is an effective treatment for localized, superficial microcystic LM in the oral cavity. Pediatric patients tolerate the treatment with rapid postoperative recovery and minimal complications. The majority of patients required a short hospital stay for observation of the airway. Virtually every patient resumed oral diet by the time of discharge. Radiofrequency ablation is the treatment of choice at Children's Hospital Boston (CHB) for patients who present with symptomatic, superficial, and localized intraoral microcystic LM. For lesions involving deeper structures, multimodal treatments including surgical and sclerotherapy may be necessary.