Complications and management of massive cervical lymphangiomas

Abstract

Objectives: To describe complications encountered in association with massive cervical lymphangiomas and treatment outcome as a function of lesion size, location and involvement. Methods: A retrospective chart review of all patients diagnosed with lymphangioma of the head and neck from January 1985 to December 2002 at a tertiary care pediatric center was performed. Patients with lesions occupying greater that 70% in 2 of 3 anatomic sites (suprahyoid, infrahyoid, and mediastinum) were included. Complications and outcomes were evaluated. Results: Of the 16 patients included, several experienced complications secondary to their lymphangiomas: 11 with respiratory compromise (8 required tracheostomy, 6 remained tracheostomy dependent, 3 mortalities), 7 with oro-digestive compromise (4 required gastrostomy), and 6 with>1 episode of infection. Other complications encountered by one patient each include hemorrhage, pneumomediastinum and surface blistering with weeping lesions. No patients were managed with observation. Marked to complete resolution of disease was achieved in 1 of 3 patients treated with sclerotherapy alone, 8 of 10 with surgical excision alone, 0 of 2 with a combination of excision and sclerotherapy and the 1 patient treated with a combination of excision and chemotherapy. Conclusion: Massive cervical lymphangiomas cause considerable aerodigestive complication in the vast majority of patients with potential fatality. Complications are more common in lesions involving the midline. Surgical intervention represents the mainstay of treatment of massive cervical lymphangiomas. Lesion extension and involvement diminishes the possibility of complete resection. In such cases, adjuvant sclerotherapy may be considered; however, these lesions appear to show a limited response to such intervention.