An Oral Cavity Mass in a 5-Year-Old Girl

Lymphatic malformations are rare congenital vascular anomalies that most commonly affect the head and neck regions. Cervicofacial lesions extending into the oral cavity or upper airway can result in dysphagia, bleeding, malnutrition, and airway obstruction. Emergency assessment is particularly challenging because significant anatomic distortion can exist even when physiologic parameters remain stable, necessitating thorough airway evaluation and early anticipation of potential clinical deterioration.

A 5-year-old girl who had recently emigrated from Peru presented with a progressively enlarging oral mass, resulting in impaired speech, inability to close her mouth, dysphagia, intermittent mucosal bleeding, and poor weight gain necessitating gastrostomy. She had a history of prior airway obstruction requiring tracheostomy. On presentation, she was tachycardic but maintained adequate oxygenation without stridor or respiratory distress. Physical examination revealed macroglossia with purpuric lingual blebs, mandibulomegaly, and mucosal bleeding. Emergency management focused on airway assessment, continuous monitoring, airway preparedness, and early multidisciplinary consultation. Laboratory evaluation demonstrated severe microcytic anemia, likely secondary to chronic bleeding. The patient was admitted for controlled magnetic resonance imaging with anesthesia support, which identified a large transspatial cervicofacial mass involving the lower face, floor of mouth, submandibular regions, and tongue base. Biopsy confirmed a microcystic lymphatic malformation. Management included transfusion, nutritional optimization, staged sclerotherapy, lymphatic embolization, partial glossectomy, and mucosal resurfacing. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Children with extensive cervicofacial lymphatic malformations may appear clinically stable despite having high-risk airway anatomy. Emergency physicians should recognize the potential for rapid deterioration, avoid unnecessary airway manipulation, assess for complications such as bleeding and anemia, seek early multidisciplinary consultation, and consider admission for imaging or procedures under controlled conditions.