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Transoral Sclerotherapy for Deep Space Cervical Lymphatic Malformations in Children With Acute Airway Compromise
1Pediatric Otolaryngology, Cohen Children's Medical Center, New Hyde Park, NY, USA Department of Otolaryngology-Head and Neck Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
Insights
Transoral sclerotherapy offers a less invasive alternative to tracheotomy for children with deep neck lymphatic malformations causing airway compromise. This effective technique provides direct access for treating these rare but critical conditions.
Area of Science:
- Pediatric Otolaryngology
- Vascular Anomalies
- Minimally Invasive Surgery
Background:
- Cervical lymphatic malformations (CLMs) in children can lead to acute airway compromise, particularly when involving deep neck spaces.
- Hemorrhage or acute exacerbation of CLMs may precipitate critical airway obstruction, necessitating urgent intervention.
- Tracheotomy is the traditional management for impending airway obstruction due to deep space CLMs.
Observation:
- This study details the experience with two pediatric patients presenting with acute airway compromise secondary to deep space CLMs.
- The presented technique involves direct laryngoscopy-assisted transoral sclerotherapy using doxycycline.
Findings:
- Direct laryngoscopy-assisted transoral sclerotherapy with doxycycline is a viable alternative to tracheotomy for retropharyngeal and parapharyngeal space CLMs.
- The procedure demonstrated effectiveness in managing airway compromise caused by deep space CLMs.
Implications:
- Transoral sclerotherapy provides an effective, less invasive treatment option for pediatric deep space CLMs.
- This approach offers direct access and avoids the need for tracheotomy in select cases, improving patient outcomes.
Introduction:
Cervical lymphatic malformations in children rarely present with acute airway compromise. During an acute exacerbation or hemorrhage, lymphatic malformations involving the deep neck spaces may precipitate critical airway obstruction. These are rare clinical entities and tracheotomy is the standard procedure to bypass impending airway obstruction.
Methods:
We present our recent experience with 2 children presenting with acute airway compromise resulting from deep space cervical lymphatic malformations and describe our technique and success with transoral sclerotherapy.
Results:
Direct laryngoscopy-assisted transoral sclerotherapy with doxycycline may be considered an alternative to tracheotomy to address retropharyngeal and parapharyngeal space lymphatic malformations.
Conclusions:
Direct laryngoscopy-assisted transoral sclerotherapy is an excellent treatment option for children with deep space cervical lymphatic malformations with airway compromise. It is effective, provides direct access, and can be an alternative to a tracheotomy.
