title: Doxycycline sclerotherapy in children with head and neck lymphatic malformations.
abstract: OBJECTIVE
  This is a systematic review of the literature describing doxycycline sclerotherapy (DS) to treat pediatric head and neck lymphatic malformations and examine patient factors associated with treatment success.
  
  
  METHODS
  PubMed, EMBASE, and Ovid.
  
  
  METHODS
  A query of PubMed, EMBASE, and Ovid search engines (1995-2014) for studies examining outcomes for doxycycline sclerotherapy (DS) as primary treatment strategy for children with head and neck lymphatic malformations was undertaken. Successful outcome was defined as clinical resolution of symptoms or greater than 50% reduction in radiographic involvement.
  
  
  RESULTS
  Five studies met the inclusion criteria for review. All were retrospective case series reports with high risk of bias. The dose of doxycycline used in all but one of the studies was 10mg/mL, and the highest concentration administered was 20mg/mL. Thirty-eight children met the inclusion criteria for analysis. Thirty-two (84.2%) children were successfully treated with DS, with 23 (60.5%) utilizing only one treatment session. Average follow-up was 9.7months. Age, gender, de Serres stage 1, and type of lymphatic malformation were not related to successful treatment outcome (p=0.23, 1, 1, and 0.13, respectively).
  
  
  CONCLUSIONS
  DS is very effective for treatment of macrocystic and mixed head and neck lymphatic malformations in children. Overall success with DS treatment in children with lymphatic malformation of the head and neck was 84.2%. DS has distinct advantages over other sclerotherapy agents including that it is inexpensive and widely available, and has minimal side effects. No associated patient characteristics were found to predict improved success.
authors.affiliation: Division of Pediatric Otolaryngology, Cohen Children's Medical Center, New Hyde Park, NY, USA; Department of Otolaryngology-Head and Neck Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA. Electronic address: jcheng2@nshs.edu.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cheng
mesh_terms: D000293:Adolescent; D002648:Child; D004318:Doxycycline / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006257:Head; D006801:Humans; D007223:Infant; D044148:Lymphatic Abnormalities / Q000628:therapy*; D008297:Male; D009333:Neck; D012597:Sclerosing Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D015911:Sclerotherapy / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D012597:Sclerosing Solutions; D004318:Doxycycline
keywords: Cystic hygroma; Doxycycline; Lymphangioma; Lymphatic malformation; Sclerotherapy