Multimodality treatment of pediatric lymphatic malformations of the head and neck using surgery and sclerotherapy.
OBJECTIVE
To describe a multimodality approach to the management of pediatric head and neck lymphatic malformations using surgery, sclerotherapy, or both and to review the outcomes of these approaches.


METHODS
Retrospective case series.


METHODS
A single pediatric tertiary care referral center.


METHODS
Ninety-seven pediatric patients (aged 1 month to 16 years) diagnosed as having lymphatic malformations of the head and neck during a 7-year period. Follow-up ranged from 3 months to 7 years.


METHODS
All of the patients underwent clinical and radiologic (magnetic resonance imaging) assessment. Treatment modality was selected according to disease location, cyst size, and parental preference. Treatments included surgery (open excision, tongue reduction, electrocautery, and laser treatment), sclerotherapy with OK-432 (Picibanil) or a fibrosing agent (Ethibloc), and a combination of modalities.


METHODS
Clinically determined responses to treatment, complications, and number of treatments required.


RESULTS
All isolated neck disease had complete or near-complete responses, with no nerve palsies sustained. Although most patients achieved complete or near-complete responses, disease with parotid, laryngopharyngeal, or oral components had poorer outcomes and frequently required multiple treatments. Significant long-term neural injury was sustained in 3 of 6 surgical patients for mediastinal disease and in only 4% (n = 4) of other surgical procedures.


CONCLUSIONS
Surgery retains an important role in the treatment of pediatric head and neck lymphatic malformations despite the advent of sclerotherapy. Isolated neck disease has an excellent outcome with either modality. Treatment decisions were made via a problem-based approach and were individualized according to anatomical location and disease classification.
Departments of Paediatric Otolaryngology, Great Ormond Street Hospital for Children, London, England. simoneboardman@hotmail.com
Simone J
SJ
Boardman
Lesley A
LA
Cochrane
Derek
D
Roebuck
Martin J
MJ
Elliott
Benjamin E J
BE
Hartley
D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003973:Diatrizoate / Q000627:therapeutic use; D004338:Drug Combinations; D004564:Electrocoagulation; D005227:Fatty Acids / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053685:Laser Therapy; D044148:Lymphatic Abnormalities / Q000628:therapy*; D008297:Male; D010844:Picibanil / Q000627:therapeutic use; D011183:Postoperative Complications; D011409:Propylene Glycols / Q000627:therapeutic use; D019233:Retreatment; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015911:Sclerotherapy; D018084:Ultrasonography, Interventional; D015028:Zein / Q000627:therapeutic use
D000970:Antineoplastic Agents; D004338:Drug Combinations; D005227:Fatty Acids; D011409:Propylene Glycols; D012597:Sclerosing Solutions; D003973:Diatrizoate; D010844:Picibanil; D015028:Zein; C020481:alcoholic prolamine solution