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Multistage Sclerotherapy for Extensive Lymphatic Malformations With Airway Involvement in Infant: A Protocol to
An-Wei Chen1, Tao Wang1, Ying-Ying Huang2
1Attending Staff, Department of Oral and Maxillofacial Surgery, Qilu Hospital and the Institute of Stomatology, Shandong University, Jinan, China.
Insights
Multistage sclerotherapy using bleomycin A5 effectively treated extensive head and neck lymphatic malformations in infants, preventing the need for tracheotomy. This approach offers a safe and viable alternative for managing airway compression in these challenging cases.
Area of Science:
- Pediatric Surgery
- Vascular Anomalies
- Interventional Radiology
Background:
- Extensive head and neck lymphatic malformations (LMs) pose significant management challenges in infants, primarily due to the risk of life-threatening upper airway compression.
- Tracheotomy is often considered, but carries its own set of risks and complications in this vulnerable population.
Purpose of the Study:
- To present a management protocol for extensive head and neck lymphatic malformations in infants with airway involvement.
- To evaluate the clinical outcomes of this protocol, focusing on preventing tracheotomy.
Main Methods:
- A cohort of 15 infants with extensive head and neck LMs and airway involvement was treated between August 2010 and September 2015.
- Multistage sclerotherapy using bleomycin A5 was administered, with individualized adjustments to anesthesia, treatment timing, and sclerosant concentration.
- Patients underwent regular follow-up for at least 12 months to assess lesion response and airway complications.
Main Results:
- All patients achieved a >50% decrease in lesion volume after an average of 5 treatment sessions.
- Morphologic resolution was observed in 20% of cases, with a substantial response in 80%.
- No patient required tracheotomy, and no upper airway obstruction occurred, although some experienced temporary swelling or feeding difficulties.
Conclusions:
- Multistage sclerotherapy with bleomycin A5 is a safe and effective treatment for extensive head and neck LMs in infants with airway compromise.
- Implementing a standardized perioperative protocol is crucial for minimizing airway complications and improving patient outcomes.
Purpose:
The management of extensive head and neck lymphatic malformations (LMs) in infants is challenging because of life-threatening upper airway compression. The aim of this study was to present a management protocol and evaluate the clinical outcomes for preventing tracheotomy in these patients.
Materials And Methods:
Fifteen infants with extensive head and neck LMs and airway involvement were enrolled from August 2010 through September 2015 at the Qilu Hospital of Shandong University (Jinan, China). According to various key factors associated with airway compression of patients in the perioperative period, different anesthesia types, treatment times, sclerosant concentrations, and sclerotherapy protocols were used. Multistage sclerotherapy was performed with bleomycin A5. All patients were followed at 1, 3, 6, and 12 months. More extended follow-up was offered if patients had a residual lesion requiring supplementary sclerotherapy. Reviews on the site and size of the lesion, times and durations of treatments, therapeutic response, airway complications, and conduction of tracheotomy were performed.
Results:
LM lesions in the head and neck were located in the floor of the mouth, tongue, and neck. An overall average of 5 treatments was required; a lesion volume decrease of more than 50% was achieved in all patients. For efficacy, morphologic resolution was achieved in 3 of 15 cases (20%), and there was a substantial response in 12 of 15 cases (80%). Eight of 15 patients (53.3%) with microcystic LMs exhibited immediate swelling and had more serious upper airway symptoms than preoperatively, and 2 of 15 patients (13.3%) had feeding difficulty. No upper airway obstruction occurred and no tracheotomy was performed in the patients in this study.
Conclusions:
Multistage sclerotherapy with bleomycin A5 is a safe and effective treatment for extensive head and neck LMs in infants with airway involvement. A routine perioperative protocol is essential for decreasing airway complications.