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Multidisciplinary therapeutic strategy with appropriate timing and modalities for treating cervicofacial lymphatic

Kento Suzuki1, Shigehisa Fumino2, Masafumi Iguchi1

  • 1Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.

Pediatric Surgery International
|December 19, 2024
PubMed

Insights

A multidisciplinary approach effectively treats pediatric cervicofacial lymphatic malformations (CFLMs). Strategies include watchful waiting, sclerotherapy, sirolimus, and surgery, significantly improving children's quality of life.

Area of Science:

  • Pediatric Surgery
  • Vascular Anomalies
  • Lymphatic Malformations

Background:

  • Cervicofacial lymphatic malformations (CFLMs) present unique challenges in pediatric treatment.
  • A multidisciplinary approach is crucial for managing these complex vascular anomalies.

Purpose of the Study:

  • To review a multidisciplinary treatment strategy for pediatric CFLMs.
  • To evaluate the efficacy of various interventions including observation, sclerotherapy, sirolimus, and surgery.

Main Methods:

  • Retrospective review of 53 children with CFLMs treated between 2007 and 2023.
  • Prioritized airway management and "wait-and-see" policy for infants.
  • Utilized OK-432 sclerotherapy, surgical resection, and sirolimus for residual or older-child lesions.

Main Results:

  • Overall, 23 of 30 infants achieved moderate to excellent improvement.
  • 16 of 23 older children improved spontaneously, with 7 showing good response to sclerotherapy.
  • Sirolimus treatment led to moderate shrinkage or bleeding cessation in 6 patients.

Conclusions:

  • Early sclerotherapy in infants, especially near the airway, carries risks; tracheostomy may be required.
  • A comprehensive strategy combining "wait-and-see," sclerotherapy, sirolimus, and surgery improves pediatric CFLM outcomes.
  • This integrated approach significantly enhances patients' quality of life.
Abstract

Keywords:
CervicofacialLymphatic malformationsOK-432 sclerotherapySirolimusSurgeryTracheostomy

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