Large Cystic Lymphangiomas of the Neck: A Surgical Challenge

Cystic hygroma, a congenital malformation of the lymphatic system, predominantly affects pediatric populations but can also present in adults, posing unique diagnostic and therapeutic challenges. This study aims to document the clinical and radiological extent and involvement of important neurovascular structures and also the outcome of patients treated for large cystic hygroma in the head and neck region.

A retrospective analysis of medical records was conducted for all 33 patients who underwent surgical excision of large cystic hygromas in our hospital. The data collected included patient age, sex, lesion location, anatomical stage (using the de Serres classification), morphological type (cavernous or macrocytic), surgical outcomes, postoperative complications, and recurrences.

The study population comprised 22 (66.7%) pediatric patients (<18 years), with a 21 (63.6%) male predominance. According to the de Serres classification, 24 (72.7%) patients presented with stage III disease, involving both the suprahyoid and infrahyoid regions. Morphologically, lesions of 19 (57.5%) patients were cavernous, while 14 (42.4%) were macrocystic. Complete surgical excision was achieved in all patients. Postoperative complications occurred in eight (24.24%) patients, including transient injury to the marginal mandibular branch of the facial nerve in three (9.09%) patients and transient paralysis of the facial nerve in one (3.03%) patient. Recurrence was seen in four (12.12%) patients.

Cystic hygromas are congenital lymphatic malformations frequently involving the head and neck. Surgical excision remains the mainstay of treatment for large lesions, though it poses technical challenges due to proximity to vital neurovascular structures. With meticulous dissection, complications can be minimized. Sclerotherapy is effective for smaller lesions but is less suitable for extensive disease. Recurrence is uncommon following complete surgical excision.