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Surgical Excision With Bleomycin Irrigation: A Better Primary Treatment Choice for Pediatric Submandibular Lymphatic
Lei Jin1, Jiarui Chen1, Xiaoyan Li2
1Attending, Department of Otorhinolaryngology, Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Purpose:
To compare the efficacy of surgical excision combined with intralesional bleomycin irrigation with that of needle aspiration with intralesional bleomycin sclerotherapy (IBS) in pediatric submandibular lymphatic malformations (LMs).
Materials And Methods:
The medical records of 32 patients were analyzed. Clinical response was categorized by improvement in size as determined by imaging studies and calculations of lesion volume. An excellent response was defined as a decrease in volume greater than 90%, a satisfactory response was defined as a decrease greater than 50%, and a poor response was defined as a decrease less than 50%. In addition, the authors developed a new scale to quantify treatment outcome. This scoring system is composed of 6 parts: size decrease, esthetic problem, functional problem (eg, breathing, eating, and speech), postoperative complications, necessity for further intervention, and times of intervention. Pearson χ2 and t tests were used to compare treatment outcome between the 2 groups.
Results:
The average age at first treatment was 2 years. Twenty-two patients underwent surgical excision with bleomycin irrigation as the primary treatment. Three of the 22 underwent 2 rounds of cyst aspiration with IBS during follow-up. IBS was performed as the primary treatment in 10 patients. All patients underwent a single surgery, and the number of IBS procedures per patient varied from 1 to 3 (mean, 1.8). In the surgical group, 72.7% of patients (16 of 22) showed an excellent response, 18.2% (4 of 22) showed a satisfactory response, and 9% (2 of 22) showed a poor response. The surgical excision group had a significantly higher excellent response rate than the sclerotherapy group (P < .05). According to the new scale, there was a marked difference between the mean values of the 2 groups (14.2 ± 2.1 vs 9.8 ± 1.8), and surgical excision with bleomycin irrigation showed better efficacy than IBS.
Conclusion:
Surgical excision with bleomycin irrigation is a better primary treatment for pediatric submandibular LMs. Cyst aspiration with IBS is a good method to treat localized recurrence.
