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Considerations for Management of Head and Neck Lymphatic Malformations in Children
Jeffrey Cheng1, Nicholas Bastidas
1*Division of Pediatric Otolaryngology, Cohen Children's Medical Center, New Hyde Park †Department of Otolaryngology - Head and Neck Surgery, Northwell Health School of Medicine ‡Division of Plastic Surgery, Cohen Children's Medical Center §Department of Surgery, Hofstra Northwell Health School of Medicine, Hempstead, NY.
Insights
A new classification system for pediatric head and neck lymphatic malformations offers improved management guidance. This system aids healthcare providers in communication and treatment decisions for these complex conditions.
Area of Science:
- Pediatric Surgery
- Head and Neck Surgery
- Vascular Anomalies
Background:
- Existing classification systems for pediatric head and neck lymphatic malformations lack comprehensive management guidance.
- Improved communication among healthcare providers is crucial for optimal patient care.
Purpose of the Study:
- To propose a novel organization scheme for head and neck lymphatic malformations in children.
- To provide evidence-based management recommendations for these conditions.
Main Methods:
- Retrospective chart review of a consecutive series of pediatric patients with head and neck lymphatic malformations.
- Development and comparison of a proposed staging system against established systems (de Serres, Cologne Disease Score).
Main Results:
- Seventeen pediatric patients were analyzed, with diverse management approaches including expectant, sclerotherapy, and surgical excision.
- All actively treated patients achieved successful outcomes without complications; expectant management also showed no failures.
- The proposed staging system demonstrated significant differences compared to the de Serres stage, often downstaging patients.
Conclusions:
- Individualized treatment strategies are essential for children with head and neck lymphatic malformations.
- The proposed classification system addresses weaknesses in current staging methods and informs management decisions.
Objective:
There exist inherent problems with previously described classification schemes for head and neck lymphatic malformations in children and lack of guidance for management. An organization scheme and management recommendations are proposed to improve communication between health care providers.
Study Design:
Consecutive patient series with a chart review of children with head and neck lymphatic malformations.
Setting:
Tertiary-care, academic children's hospital.
Methods:
Children with lymphatic malformations of the head and neck were included. A proposed organization system for head and neck lymphatic malformations in children was developed and compared to 2 others currently predominantly used, de Serres and Cologne Disease Score.
Results:
Seventeen patients were identified, 7 boys and 10 girls. The mean age was 64.4 months (range 0.89-185.5). Nine patients (52.9%) were managed expectantly, 5 (29.4%) with sclerotherapy with 1 awaiting treatment (5.9%), and 2 (11.8%) with surgical excision. All children who underwent active treatment with surgery or sclerotherapy were managed successfully. No treatment-related complications were encountered, and no children managed with watchful waiting/expectant management experienced failure. The proposed staging system differed from the de Serres stage in 11 children (64.7%), with 9 (81.8%) being down staged and 2 (18.2%) up staged. Cologne Disease Score ranged from 2 to 10, with only 1 (5.9%) patient with a score of 3 or less (severe disease).
Conclusions:
Treatment recommendations in children with head and neck lymphatic malformations should be individualized. Weaknesses of currently used staging systems are discussed as well as considerations for management decisions.
