Radiofrequency ablation for tongue lymphatic malformations in children: A retrospective cohort study

The aim of this study was to evaluate the safety and clinical outcomes of radiofrequency ablation for tongue lymphatic malformations in a paediatric population and to explore predictors of symptom control.

A retrospective cohort study was conducted of all paediatric patients who underwent transoral radiofrequency ablation to a tongue lymphatic malformation between 2018 and 2025. The primary outcome of interest was successful control of symptoms with radiofrequency ablation alone. Secondary outcomes of interest included the degree of symptom control, complications following surgery and additional treatment types required. Non-parametric data was analysed using Mann-Whitney U test. Statistical significance was defined as p value < 0.05.

A total of 44 children were included. Lesions were classified using the Wiegand system. Stage I in 12 patients (27.3%), IIa in 5 (11.4%), IIb in 4 (9.1%), III in 12 (27.3%), IV in 11 (25.0%). Mixed disease predominated at higher stages, with 10 of the 11 stage IV lesions being mixed. Twenty-five (56.8%) patients had mixed microcystic and macrocystic disease whereas 19 patients (43.2%) had isolated microcystic disease. Symptom control with radiofrequency ablation alone was achieved in 73.8% patients (n = 31/42), with 100% Wiegand I patients, 4/5 (80%) Wiegand IIa patients, 4/4 (75%) Wiegand IIb, 7/12 (58.3%) Wiegand III, and 6/10 (60%) Wiegand IV patients achieving symptom control. Older age of first treatment was predictive of symptom control with radiofrequency ablation alone (p = 0.005). No statistically clear associations were observed for sex, prior therapies, or individual pre-operative symptom categories. Symptom improvement was recorded in 93.2% of patients (41/44). No patients reported worsening of symptoms. Nine patients required alternative therapies mainly to treat residual tongue swelling.

Radiofrequency ablation appears to be a safe and effective treatment option for managing symptomatic microcystic and mixed tongue lymphatic malformations and is useful as part of a multimodal treatment strategy. It was favoured particularly for controlling bleeding and improving surface related symptoms.