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Cervicofacial Lymphangioma: Is it Time to Put Down the Scalpel?
Fatemeh Mirashrafi1, Goli Golpayegani1, Houman Alizadeh2
1Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Intralesional bleomycin injections effectively treat pediatric head and neck lymphangiomas. This treatment led to significant size reduction and complete disappearance in most young patients, with minimal side effects.
Area of Science:
- Pediatric Otolaryngology
- Oncology
- Dermatology
Background:
- Pediatric lymphangiomas, particularly macrocystic types in the head and neck, present significant treatment challenges.
- Current therapeutic options may have limitations in efficacy or safety for pediatric patients.
Purpose of the Study:
- To evaluate the effectiveness of intralesional bleomycin as a primary treatment for pediatric macrocystic lymphangiomas in the head and neck.
- To assess the safety and complication profile of this therapeutic approach in the Iranian pediatric population.
Main Methods:
- A prospective study involving 20 pediatric patients with head and neck macrocystic lymphangiomas.
- Intralesional bleomycin (0.5 mg/kg at 1 mg/ml concentration) injections administered, with ultrasonography for size assessment at 1, 3, 6, and 12 months post-injection.
- Data collected on patient demographics, injection details, lymphangioma size changes, and adverse events.
Main Results:
- An average reduction in lymphangioma size of 84% was achieved.
- Complete resolution of the mass occurred in 65% of patients, with an additional 25% showing over 50% size reduction.
- Minor, transient side effects like erythema and swelling were observed; no respiratory complications arose.
Conclusions:
- Intralesional bleomycin is a highly effective first-line treatment for macrocystic lymphangiomas of the head and neck in pediatric patients.
- The procedure demonstrates a favorable safety profile with a low incidence of significant complications.
- This approach offers a promising therapeutic option for managing pediatric head and neck lymphangiomas.
Abstract:
To assess the efficacy of intralesional injection of bleomycin for treatment of pediatric lymphangiomas in head and neck region in Iranian population. This prospective study was conducted from February 2017 to March 2019. All consecutive patients presented to pediatric otolaryngology clinic in Children Medical Center Hospital in Tehran with macrocystic lymphangiomas of head neck were enrolled in this study. Informed consent was taken from parents. Bleomycin was diluted to a concentration of 1 mg/ml by normal saline and a dose of 0.5 mg/kg was injected into the lymphangioma. Ultrasonography was performed before and after each injection at 1, 3, 6 and 12 months. Age, gender, number of injections, size of lymphangioma and complications including fever, discoloration and respiratory problems were recorded. A total of 20 patients were assessed. Mean age at first injection was 31.9 months. Average reduction in size was 84%. Complete disappearance of mass was observed in 65% (13/20) of patients. Twenty-five percent (5/20) of patients had more than 50% reduction in size. Ten percent (2/20) had unsatisfactory results. Three patients developed transient erythema or swelling of injection site, but none of the patients had any respiratory problem. Intralesional injection of bleomycin is an effective modality to use as a first-line treatment of macrocystic head and neck lymphangiomas in Iranian pediatric population.
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