title: Sclerotherapy for lymphatic malformations of the head and neck in the pediatric population.
abstract: BACKGROUND
  Sclerotherapy is one of the most commonly used minimally invasive interventions in the treatment of macrocystic lymphatic malformations (LMs). Several different sclerosing agents and injection protocols have been reported in the literature, each with varying degrees of success. The safety and efficacy of the treatments have not been evaluated comparatively in the pediatric population.
  
  
  METHODS
  Chart review of pediatric patients with macrocystic/mixed head and neck LMs who underwent sclerotherapy using OK-432, doxycycline, or ethanolamine oleate at Lucile Packard Children's Hospital at Stanford during 2000-2014. Clinical evaluation and radiographic imaging were reviewed to assess lesion characteristics and response to sclerotherapy following each treatment session. The post-intervention clinical response was categorized as excellent, good, fair, or poor.
  
  
  RESULTS
  Among the 41 pediatric cases reviewed, 10 patients were treated with OK-432, 19 patients received doxycycline, and 12 patients received ethanolamine. In univariate analysis, different sclerosants had similar effectiveness after the first injection and final clinical outcome (p=0.5317). In multivariate analysis controlling for disease severity stage as well as disease characteristics (macrocystic vs mixed subtypes), different sclerosants also had similar effectiveness after the first injection (p=0.1192). Radiologic analysis indicated an 84.5% average volume reduction, with similar effectiveness between the different sclerosants (p=0.9910).
  
  
  CONCLUSIONS
  In this series of LM cases treated at Stanford, we found that doxycycline, OK-432, and ethanolamine oleate sclerotherapy appear to have a similar safety and efficacy profile in the treatment of macrocystic and mixed LMs of the head and neck in the pediatric population.
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, New York, USA.|Department of Dermatology, Stanford University, Palo Alto, California, USA.
authors.forename: Joanna H
authors.initials: JH
authors.lastname: Tu
authors.affiliation: Departments of Radiology and Neurosurgery, Stanford University, Palo Alto, California, USA.
authors.forename: Huy M
authors.initials: HM
authors.lastname: Do
authors.affiliation: Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Viraat
authors.initials: V
authors.lastname: Patel
authors.affiliation: Department of Radiology, Stanford University, Palo Alto, California, USA.
authors.forename: Kristen W
authors.initials: KW
authors.lastname: Yeom
authors.affiliation: Department of Dermatology, Stanford University, Palo Alto, California, USA.
authors.forename: Joyce M C
authors.initials: JMC
authors.lastname: Teng
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D006257:Head / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D044148:Lymphatic Abnormalities / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D009333:Neck / Q000000981:diagnostic imaging*; D009829:Oleic Acids / Q000627:therapeutic use; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D009829:Oleic Acids; D012597:Sclerosing Solutions; D004318:Doxycycline; C033343:ethanolamine oleate
keywords: Intervention; Malformation; Neck; Pediatrics; Vascular Malformation