OK-432 Sclerotherapy Research Articles

Comparison of the Efficacy and Safety of Single-Session OK-432 and Multiple-Session 99% Ethanol Sclerotherapy for Symptomatic Simple Hepatic Cysts

PurposeThis retrospective study aimed to compare the efficacy and safety of single-session OK-432 and multiple-session 99% ethanol sclerotherapy for symptomatic simple hepatic cysts.MethodsWe reviewed patients who received aspiration sclerotherapy with OK-432 (group A) or 99% ethanol (group B) for symptomatic simple hepatic cysts at Guangdong Provincial People's Hospital from January 2013 to November 2019.ResultsWe included 42 patients in group A and 39 patients in group B. No significant difference was found in the mean volume of hepatic cysts between the two groups. The overall success rates were 92.9% (39 of 42 patients) in group A and 79.5% (31 of 39 patients) in group B (P = 0.08). The treatment success for cyst volumes <200 ml, 200–500 ml, and >500 ml was 100, 93.3, and 88.2% in group A, and 100, 84.6, and 57.1% in group B, respectively. The symptomatic relief rate in group A was higher than that in group B for cysts ≥500 ml (P = 0.049) and cysts <500 ml. For treatment-related complications, the incidence of pain at the injection site in group A was lower than that in group B.ConclusionSingle-session OK-432 sclerotherapy was safer and more effective than multiple-session 99% ethanol sclerotherapy for treating large cysts, although both treatments had similar effects on small cysts.

Sclerotherapy With OK-432 for the Treatment of Symptomatic Lymphocele After Lymph Node Dissection: A Retrospective Comparative Cohort Study.

This study aimed to determine the benefits of sclerotherapy with OK-432 for the treatment of postoperative chronic lymphocele. Postoperative chronic lymphocele formation is common and accounts for a high postoperative morbidity. Nonsurgical strategies comprise repetitive percutaneous fluid aspiration or percutaneous sclerotherapy. OK-432 has been used to treat congenital lymphatic malformations with several reports of promising results. We hypothesized that it is more beneficial than repetitive percutaneous fluid aspiration for the treatment of symptomatic lymphocele. Two cohorts of melanoma patients who developed recurrent lymphocele after lymph node dissection from January 2013 to August 2017 were compared. The first cohort was treated with repetitive percutaneous fluid aspiration (n = 20). The second cohort received OK-432 sclerotherapy (n = 20). Primary end points were overall treatment duration, number of treatment sessions, and the clinical success in both cohorts. Secondary end points were surgical site infection rate, need for additional antibiotic treatment, wound healing disorders, and the need for revision surgery. Mean overall duration of treatment with sclerotherapy was significantly shorter than with repetitive aspiration (9.4 ± 7.2 vs 47.5 ± 31.9 days, P < 0.01). Mean number of sclerotherapy treatment sessions were 2.5 ± 1.2. Clinical success with OK-432 was 19 of 20, and that with repeated aspiration was 7 of 20 (χ = 15.82, P < 0.001). No surgical site infection occurred in the sclerotherapy cohort, which was significantly lower than those treated with repetitive aspiration (P < 0.03). Surgical revision was mandatory in 12 of 20 patients who were treated with repetitive aspiration, and only 1 of 20 patients in the sclerotherapy cohort. Sclerotherapy with OK-432 for the treatment of postoperative lymphocele is highly beneficial with a significant reduction of morbidity and the overall treatment time compared with repetitive aspiration.

The efficacy of OK-432 sclerotherapy on thyroglossal duct cyst and the influence on a subsequent surgical procedure

Background: Although there are studies regarding the efficacy of OK-432 sclerotherapy on thyroglossal duct cyst (TDC), its effects on surgical procedure following this therapy have not been properly described.Objectives: The present study aimed to delineate the prognostic factors of OK-432 sclerotherapy in patients with TDC and investigate its influence on subsequent surgical procedure and the histological characteristics in patients with poor response to OK-432 sclerotherapy.Material and methods: We conducted a retrospective analysis of the medical records of 20 TDC patients treated with OK-432 sclerotherapy.Results: Of the 20 patients, OK-432 sclerotherapy was effective in 5 patients (25.0%). OK-432 showed a lower effective rate in multilocular cysts (9.1%) than in unilocular cysts (44.4%), although not significantly. Five cases were treated with surgery following OK-432 sclerotherapy. There was no significant difference in the operating time and the amount of bleeding between patients with and without OK-432 sclerotherapy. From the results of the histological examination of the cyst wall, two cases had stratified squamous epithelium and two cases showed the absence of lymphocyte infiltration.Conclusion and significance: OK-432 sclerotherapy is an acceptable initial treatment for TDC, especially in unilocular cysts, because of lack of influence on surgical procedure.

Long-term health-related quality of life in children with lymphatic malformations treated with sclerotherapy generally matched age-appropriate standardised population norms.

We assessed the long-term health-related quality of life (HRQoL) of children who received sclerotherapy for lymphatic malformations. This treatment involved injecting drugs into the blood vessels to make them shrink. Our cross-sectional study retrospectively reviewed patients who received OK-432 sclerotherapy injections at Karolinska University Hospital, Stockholm, Sweden, from 1998 to 2013. We studied 49 patients (63% female) aged 8-18 at least five years after their first injection. HRQoL was assessed with the KIDSCREEN-52 questionnaire and a study-specific questionnaire addressed disease consequences and patient satisfaction. We determined associations between HRQoL and disease and treatment and the patient's sex. Overall HRQoL paralleled age-appropriate norms in the general population, but some subgroups had lower levels. Regression-based estimates showed that larger numbers of injections were negatively associated with HRQoL in the dimensions autonomy, parent relations and home life, financial resources and school environment (p=0.01-0.03). Malformations in the head and neck area were negative predictors across dimensions and were strongest for psychological well-being (p=0.009), parent relations and home life (p=0.017) and school environment (p=0.006). Despite generally positive outcomes, multiple injections and malformations in the head and neck were associated with impaired HRQoL.

Surgical management of recurrent TMJ dislocation-a systematic review.

Recurrent temporomandibular joint (TMJ) dislocation can be challenging to treat and the current understanding regarding aetiology and management of this condition is limited. The aim of this paper was to conduct a systematic review regarding the management of recurrent TMJ dislocation. A literature review was conducted using PRISMA guidelines to identify papers published between 2006 and 2016. The resultant papers were analysed. A total of 33 papers were found relevant to the study. Minimally invasive techniques described included autologous blood injection, which was associated with an overall success of 80% at 12months. Other modalities investigated included OK-432 sclerotherapy, laser capsulorrhaphy, botulinum toxin of the lateral pterygoid muscle or modified dextrose. These publications show promising success rates. Surgical techniques described included disc plication, eminoplasty and eminectomy. These modalities had a similar success rate, although numbers were limited. The true incidence of recurrent TMJ dislocation is unknown and aetiology is limited to expert opinion. The current understanding of management for recurrent TMJ dislocation is limited to case series and case reports. This paper compiles the current understanding of management of recurrent TMJ dislocation. Compared to previous reviews, this paper describes some novel minimally invasive techniques with promising success in the management of recurrent TMJ dislocation.

Treatment of giant cervico-mediastinal lymphatic malformations: a case\xa0series

BackgroundLymphatic malformations are histologically benign vascular structures that vary in anatomic lesion and size. Extensive head and neck lymphatic malformations may be life-threatening. In the present study, we described three difficult-to-treat infants with giant cervico-mediastinal lymphatic malformations accompanied by severe respiratory distress.Case presentationsCase 1. A Korean girl born at a gestational age of 37 weeks and weighing 2920 g had a large cervical mass compressing the trachea. Despite initial OK-432 sclerotherapy, the mass extended over the contralateral retropharyngeal space and mediastinum. Although the cervical mass was completely excised, our patient was not weaned off the ventilator. The mediastinal lymphatic malformation was excised, and our patient underwent continued intensive respiratory care with nasal continuous positive airway pressure for 6 months. She is now 5 years old and doing well without any sequelae. Case 2. A 5-month-old Korean boy showed respiratory difficulty with feeding intolerance after partial excision of a neck lymphatic malformation. We found that the remnant cervical mass had grown into the retropharyngeal space and mediastinum. After a second operation for the cervico-mediastinal mass, he experienced severe respiratory difficulty requiring ventilator care for 6 months. However, he died from central-line fungal sepsis. Case 3. A 30-day-old Korean girl was referred for remnant lymphatic malformation after partial excision. The cervical mass extended to the mediastinum and occupied half of the thoracic cavity, encasing all of the major vessels. After surgical excision, she underwent ventilator care and pleurodesis three times with doxycycline for recurrent pleural effusion. At the age of 26 months, she was weaned off supplementary oxygen and she showed normal development without any sequelae.ConclusionsDespite difficulties in the treatment process, combinations of delicate surgical treatment, appropriate adjuvant sclerotherapy, and intensive respiratory supportive care could result in a good outcome. However, complications due to long-term intensive care could still be considered.

CLOVES СИНДРОМ: КЛІНІЧНІ ПРОЯВИ ТА ОСОБЛИВОСТІ ХІРУРГІЧНОГО ЛІКУВАННЯ

Мета дослідження - встановити частоту CLOVES синдрому серед пацієнтів з лімфатичними мальформаціями, визначити особливості його клінічного перебігу та оцінити результати лікування.Матеріали і методи. Серед 126 пацієнтів з лімфатичними мальформаціями, які знаходилися на лікуванні протягом періоду від грудня 2010 до березня 2017 року на клінічній базі кафедри дитячої хірургії Національного медичного університету імені О.О.Богомольця НДСЛ «ОХМАТДИТ» CLOVES синдром діагностовано у 7 дітей, що складає 5,56%. Пацієнтів жіночої статі було 5, чоловічої - 2.Результати. Діагноз CLOVES синдрому було встановлено на основі поєднання характерних ознак, зокрема, постійними симптомами в усіх дітей були надмірні жирові розростання в ділянці тулуба, судинні мальформації з повільним кровотоком, лімфатичні (n=6, 85,71%), капілярні (n=5, 71,43%), та венозні (n=4, 57,14%); ураження опорно-рухового апарату: сколіоз (n=7, 100%), «сандальний проміжок» (n=3, 42,86%), макродактилія (n=3, 42,86%), синдактилія (n=3, 42,86%), дельтовидна форма ступні (n=1, 14,29%). При народженні виявляли окремі клінічні ознаки синдрому, прояви яких з віком прогресували, діагностували нові вади розвитку. У 7 дітей з CLOVES синдромом виконано від 1 до 6 операційних втручань. Метою операцій було видалення судинних мальформацій і жирових розростань. Операційні втручання мають свої особливості: інтраопераційна антикоагулянтна терапія (гепарин 50 U/кг/годину), виділення і поетапна перев’язка змінених венозних судин, обробка резидуальних вогнищ аргоновою коагуляцією. Склерозуюча терапія проведена у трьох пацієнтів з використанням препарату ОК-432. Консервативне лікування сколіозу з використанням корсетів Шено використано у трьох пацієнтів. Операційна корекція парціального гігантизму пальців ступні проведена в однієї пацієнтки віком 11 років.

CHOICE OF TREATMENT OPTIONS FOR CYSTIC LYMPHSTIC MALFORMATIONS IN THE HEAD AND NECK REGION: TREATMENT EXPERIENCE OF 81 CHILDREN

Background. Surgery has previously been the only treatment for lymphatic malformations (LMs), but in the head and neck region is challenging due to the risk of scarring, nerve damage, recurrence. Sclerotherapy may be a perfect alternative.Objective. The aim of the study is to determine the efficacy and safety of the OK-432 sclerotherapy in the children with craniofacial LMs.Methods. 81 children with head and neck LM between December 2010 and March 2017were involved into the study. The follow-up period was from 6 to 79 months. According to the size of cysts, LMs were classified into macrocystic, microcystic, and mixed. The result of the treatment of LMs was determined by the percentage of reduction in size as excellent (decrease by more than 90%), good (by 50%-89%), satisfactory (by 20%-49%) and none (by less than 20%).Results. The macrocystic LMs diagnosed in 41.97% of patients, microcystic - in 12.35%, and mixed – in 45.68% of children. OK-432 sclerotherapy only was performed for 83.9% of patients and in 12.3% in combination with surgery. The range of sclerotherapy sessions was from 1 to 11. An excellent result in 96.97% of cases was evidenced in the patients with macrocystic LM. Poor result was proved in the patients with microcystic LMs; the most of them (55.56%) had satisfactory result. In the patients with mixed LM, an excellent and good result was evidenced in 83.33%. After 198 sessions of OK-432 sclerotherapy, complications associated with the treatment occurred in 5 (2.52%) cases.Conclusions. OK-432 sclerotherapy is a safe and effective treatment of head and neck LMs in children. Macrocystic LMs proved the best response to OK-432 treatment.

Lymphatic Malformation Architecture: Implications for Treatment With OK-432.

Herein, the authors aim to describe their findings of novel architectural types of lymphatic malformations (LM) and explain the relationship between these architectures and OK-432 treatment outcomes. A retrospective review was conducted of all patients diagnosed with a LM treated with OK-432 at the Vascular Anomalies Clinic at BC Children's Hospital from December 2002 to January 2012. Twenty-seven patients were included in the study. Sixty percent of lesions were present by 2 years of age with the majority located in the head and neck (59%). The average number of sclerotherapy procedures was 1.4 per patient. Treatment under fluoroscopic guidance revealed 3 new LM architectures: open-cell microcystic, closed-cell microcystic, and lymphatic channel. Response to treatment was complete or good for 14/19 macrocystic and for 1/2 mixed lesions. Open-cell microcystic LMs gave a complete or good response for 3/3, which was attributed to OK-432 freely communicating between cysts. Closed-cell microcystic LM had localized cysts that did not allow OK-432 to freely communicate and were associated with partial responses, 2/2. The lymphatic channel had a partial response. There were 2 minor complications and 1 instance of recurrence. The identification of 3 new LM architectures expands the current accepted classification to include: open-cell microcystic, closed-cell microcystic, and lymphatic channels. The majority of complete responses to OK-432 were found with macrocystic lesions. Open-cell microcystic lesions respond better to OK-432 than closed-cell microcystic lesions, and lymphatic channels may respond to OK-432. These key architecture-response relationships have direct clinical implications for treatment with OK-432 sclerotherapy.

Sclerotherapy for lymphatic malformations of the head and neck in the pediatric population

BackgroundSclerotherapy 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...

耳鼻咽喉科囊胞性疾患に対する硬化療法

The aim of this study was to evaluate the indications, outcomes and limitations of OK-432 sclerotherapy in various otolaryngological cystic diseases. We analyzed the data of 148 patients with otolaryngological cystic diseases who had undergone OK-432 sclerotherapy. Of these patients, 48 (32%) had a plunging ranula, 14 (9%) had a lymphangioma, 12 (8%) had a branchial cleft cyst, 15 (10%) had a thyroglossal duct cyst, 11 (7%) had a thyroid cyst, 3 (2%) had a cervical lymphocele after neck dissection for head and neck cancer, 23 (16%) had a salivary mucocele, and 22 (15%) had an auricular hematoma. In the cases with a plunging ranula, lymphangioma, branchial cleft cyst, thyroglossal duct cyst, thyroid cyst or cervical lymphocele, we aspirated as much of the fluid content of the cystic lesion as possible, and replaced the aspirated fluid with about half the volume of OK-432 solution. In the cases with a salivary mucocele or auricular hematoma, we prepared a 0.5-Klinische Einheit (KE) of OK-432 diluted with 0.2 ml saline solution and injected this OK-432 solution into the lesion via a 27G needle to prevent leakage of the agent from the lesion. Complete disappearance of the lesion was observed in 119 of the 148 patients (80%). On the other hand, marked reduction was observed in 20 of the 148 patients (14%), partial reduction in 3 patients (2%) and no response was seen in 6 patients (4%). The responses to OK-432 therapy were better in the cases with a plunging ranula, lymphangioma, thyroglossal duct cyst, thyroid cyst, auricular hematoma or salivary mucocele than in those with a branchial cleft cyst. Local discomfort at the injection site and fever were observed as side effects in 68 (46%) and 61 (41%) of the patients, respectively, however, there were no cases of serious complications of OK-432 therapy, and the therapy seemed to have no influence on any future surgery. We undertook OK-432 therapy on an outpatient basis without hospitalization in all cases, except for the few who had the potential risk of airway obstruction. Our results confirmed that OK-432 therapy is a simple, easy, safe and effective therapeutic modality that can be used as a substitute for surgery in the treatment of various otolaryngological cystic diseases.

Postoperative adjuvant OK-432 sclerotherapy for treatment of cervicofacial lymphatic malformations: An outcomes comparison

ObjectivesSurgical treatment of extensive cervicofacial lymphatic malformations is often challenging due to a high rate of postoperative fluid re-accumulation and lesion recurrence resulting from incomplete resection. This study suggests a combined treatment of surgical resection and postoperative adjuvant OK-432 sclerotherapy via closed suction drainage. Using comparative analysis, this study aims to evaluate the efficacy of adjuvant sclerotherapy. MethodsA retrospective chart review was performed on patients who underwent surgical resection of cervicofacial lymphatic malformations between January 2009 and July 2013. Patients were divided into two groups based on whether or not adjuvant OK-432 sclerotherapy was administered via closed suction drainage after surgery. Both surgery-related and adjuvant sclerotherapy-related complications were assessed, and treatment effectiveness was measured based on the change in Cologne Disease Score (CDS) or the need for further treatment. ResultsA total of 17 patients underwent surgical resection. Nine of these patients underwent surgical resection only, while the other eight underwent surgical resection with adjuvant OK-432 sclerotherapy. The increase in total Cologne Disease Score (CDS) and change of progression parameters were significantly higher for the adjuvant sclerotherapy group compared to the surgery-only group. Additionally, there were no cases of postoperative lymphatic fluid retention among the adjuvant sclerotherapy group. The two groups exhibited similar complication rates with no statistically significant difference. ConclusionsAdjuvant OK-432 sclerotherapy via closed suction drainage is a safe and effective treatment modality. The combination of surgical resection and post-operative adjuvant sclerotherapy via closed suction drainage should be integrated into the treatment algorithm of extensive cervicofacial lymphatic malformation.

OK-432 sclerotherapy of lymphatic malformation in the head and neck: factors related to outcome

No previous study to the best of our knowledge has examined the multiple factors related to the outcome of OK-432 sclerotherapy of lymphatic malformations. This study aimed to assess factors related to the successful outcome of OK-432 sclerotherapy for lymphatic malformations in the head and neck region. During a 6-year period, OK-432 sclerotherapy was performed in 26 patients with lymphatic malformations. Several factors related to the efficacy of OK-432 sclerotherapy were evaluated, including the type (macrocystic or microcystic), the maximum lesion diameter, amount and hemorrhagic cytology of the aspirate, degree of aspiration, injected dose of OK-432 and post-therapy inflammation-related symptom. In all cases, ultrasound (US) follow-up was performed. Of the 26 cases, 13 (50%) showed successful elimination of the lymphatic malformations in the follow-up US after the initial session, and all successful cases were of the macrocystic type. The type of lymphatic malformation and the success of OK-432 sclerotherapy were significantly related (P = 0.0149). Of the 16 cases of complete aspiration, 11 (68.8%) showed a successful outcome. Further, of the 17 cases with inflammation-related symptom, 13 (76.5%) showed a successful outcome. While the degree of aspiration and presence of inflammation-related symptom showed a significant relationship with the success of OK-432 sclerotherapy (P < 0.05), no other factors showed a significant relationship. The study results suggest that the macrocystic type and complete aspiration of cystic contents were important factors for the success of OK-432 sclerotherapy of lymphatic malformations, and that inflammation-related symptom was a predictor of a successful outcome.

A new operative strategy for refractory microcystic lymphangioma

The optimal management of microcystic lymphatic malformations (LMs) in children has not been established. We describe how we used the Ligasure™ Vessel Sealing System (LVSS) to achieve partial resection of refractory microcystic LMs in a 1-year-old boy. The child was admitted in respiratory distress caused by infection and swelling of cervical LMs. The LMs had been diagnosed prenatally, but had not decreased in size despite three treatments with OK-432 sclerotherapy. We performed direct dissection of the microcystic LMs using the LVSS with minimal intraoperative blood loss or lymphatic leakage. The LMs were resected as completely as possible without damage to the jugular vein or major nerves. His postoperative course was uneventful. Histological examination revealed complete sealing of the lymphovascular channels with obliterated lumens. Resection using the LVSS is effective and easy to perform for partial resection of microcystic LMs. We recommend the combination of initial OK-432 injection therapy and subsequent partial resection using the LVSS for refractory microcystic LMs.

Efficacy of OK-432 sclerotherapy in treatment of lymphatic malformations: long-term follow-up results

Lymphatic malformations (LMs) are rare congenital tumors of the lymphatic system often affecting the head and neck area. Because of cosmetic and functional symptoms most patients need to be treated. Traditionally surgical treatment has been considered to be the first-line treatment for LM. However, it is challenging because of the need for complete excision. The risk of poor cosmetic result and damage to surrounding structures is high. Since Ogita presented OK-432 as a treatment for LM in 1987, it has been widely used as the primary treatment. Many papers have been published on this topic but with relatively short follow-up times. We present a material of 36 LMs treated with OK-432 during the period of 1999-2009 and with an average follow-up time of 6 years. Immediate post-treatment results were compared with the late follow-up findings. Primary and late response to therapy was evaluated with an MRI scan by measuring the change in lesion size. At the follow-up visit, all patients were clinically examined and they answered a symptom questionnaire. Later 26/36 patients were also available for a quality of life questionnaire. Primarily 67% demonstrated a complete or marked response. At the follow-up 64% showed a complete or marked response, in 11% the final response was better than the initially observed and only 2 patients had relapsed. The initial response predicted the long-term outcome accurately and the effect of OK-432 sclerotherapy seems to be long lasting. According to the MRI evaluation 80% and subjectively 94% of the patients benefitted from the treatment. Quality of life questionnaire showed high post-treatment satisfaction. We found OK-432 sclerotherapy to be a safe and effective treatment with a long lasting effect in the management of macrocystic LMs.

OK-432 Sclerotherapy for Malleolar Bursitis of the Ankle

The purpose of this study was to evaluate the clinical outcomes and usefulness of OK-432 (Picibanil) sclerotherapy as a new option in the conservative treatment of patients with malleolar bursitis of the ankle. Retrospectively, we reviewed a total of 20 consecutive patients (20 feet) in whom OK-432 sclerotherapy had been performed between March 2009 and June 2010. After aspiration of fluid in the malleolar bursal sac, 0.05 mg of OK-432 was injected into the malleolar bursal sac. We evaluated the clinical outcomes and side effects at the following time points: 2 weeks, 1 month, 3 months, 6 months, and 1 year after OK-432 sclerotherapy. The responses to the treatment were assessed according to the degree of fluctuation, shrinkage of the bursal sac, and soft tissue swelling. Complete resolution was observed in 19 patients (95%) after the first or second application of OK-432 sclerotherapy, and a partial response was observed in 1 patient (5%) after a second application of OK-432 sclerotherapy. The physical component scores of SF-36 improved from 70.0 ± 6.8 to 76.5 ± 7.3 at the last follow-up (P = .0002). OK-432 sclerotherapy was a useful procedure for patients not responding to the usual conservative treatment of malleolar bursitis of the ankle. Level IV, retrospective case series.

Treatment of lymphatic malformations: a more conservative approach

Background/PurposeLymphatic malformation is a benign disfiguring lesion of the neck and face in children. This study investigated the application and outcome of different modes of treatment. MethodsThe medical files of all children with lymphatic malformation of the head and neck attending a tertiary medical center in 1999 to 2010 were reviewed. Findings were compared by treatment: surgery, OK-432 sclerotherapy, or observation. ResultsThe study group included 46 patients, most (65%) with macrocystic disease. Twenty were treated by OK-432 sclerotherapy, and 15, by surgery; 11 (with minor disfigurement) were observed only. Mean follow-up time was 2.4 years. Complete removal or complete response to treatment was achieved in 67% of the surgery group and 45% of the OK-432 group; fair results (>50% reduction in swelling) were achieved in 20% and 50%, respectively. Sclerotherapy failure did not interfere with subsequent surgery. Complete spontaneous regression occurred in 5 patients under observation only. ConclusionsOK-432 sclerotherapy is associated with good aesthetic results in children with lymphatic malformation. Observation alone is sometimes sufficient. Surgery should be reserved for cases requiring a histologic diagnosis, microcystic disease, patients with an urgent clinical problem (eg, airway obstruction), and sclerotherapy failures.

New Treatment for Cystic Lymphangiomas of the Face and Neck

Cystic lymphangioma is a congenital malformation occurring most frequently in the necks of infants and young children. It is histologically benign, but the lesion can extend deep into the tissue. Thus, surgical treatment is often difficult. In recent years, OK-432 sclerotherapy has become the first-line therapy for cystic lymphangioma, and many reports have discussed its effectiveness. However, it is difficult to achieve a complete response to OK-432 in polycystic cases and cases with small cystic areas, and it is sometimes ineffective. In the current study, we performed a new combination therapy on 5 cases of cystic lymphangioma of the face and neck. In this combination therapy, we ruptured the cyst wall of lymphangioma using a liposuction device and subsequently used OK-432 to induce inflammation and to cause adhesion of cyst walls. The combination therapy produced very good results. None of the patients had any major complication or recurrence. All patients had lymphangiomas that markedly reduced in size. This new method can be performed regardless of the cyst type of lymphangioma and is thought to be a useful therapy.

Treatment of lymphatic malformations of head and neck with OK-432 sclerotherapy induce systemic inflammatory response

Systemic immune responses after OK-432 (Picibanil) sclerotherapy in patients with head and neck lymphatic malformations (LM) were examined to achieve a better understanding of the mechanism of OK-432 sclerotherapy and to evaluate the long-term treatment outcome. Serum samples from 17 consecutive patients with head and neck LMs were collected during a total of 26 OK-432 treatment episodes. Serum C-reactive protein (CRP), interleukins (IL) 1β, 6, 8, 10, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, RANTES, immune protein (IP)-10 and macrophage chemoattractant protein (MCP)-1 as well as blood leukocyte counts were determined. Clinical outcome of the treatment was evaluated at the last visit and from patient files. Elevated serum levels of IP-10 (means at baseline 702ng/L, after 1day 1180ng/L, after 4weeks 691ng/L) were seen on day one after OK-432 sclerotherapy (p<0.05). C-reactive protein and leukocyte counts 1day after treatment differed statistically significantly (p<0.05) from the baseline. No significant differences with other cytokines investigated were observed. Patients with macrocystic LM responded better than patients with microcystic LM (p=0.01). The elevated levels of IP-10, C-reactive protein and leukocyte levels indicate that OK-432 sclerotherapy induces systemic immune responses in patients with LM. The mechanisms of OK-432 sclerotherapy are still not precisely understood, but the IP-10 elevation may reflect local antiangiogenetic properties of immunoactivation induced by OK-432.

A case of bilateral intrathyroidal branchial cleft cyst in a newborn

We describe an extremely rare case of bilateral intrathyroidal branchial cleft cysts. A 2-day-old male neonate presented with intermittent tachypnea, dyspnea, and a palpable neck mass. Cervical ultrasonography and computerized tomography scan demonstrated a right-sided 3 × 3-cm cystic mass and a left sided 4.5 × 4-cm cystic mass, thought to be originating in the thyroid gland. The right-sided cyst decreased in size after OK-432 sclerotherapy. The left-sided cyst showed little response to 2 attempts of OK-432 sclerotherapy. Surgical removal of the left-sided cyst was done because of intermittent airway problems. The cystic mass was thought to be an intrathyroidal lesion. Microscopically, the cyst was lined by nonkeratinized squamous epithelium and respiratory epithelium. Lymphocyte infiltration was found in the subepithelial layer. The patient is currently doing well 12 months later with no evidence of recurrence.