Treatment of Lymphangiomas of the Head and Neck in Children

Overview

Lymphangiomas are due to their localization, extent and difficult treatment a seriousproblem not only for the patient from a cosmetic aspect with a potential social impact but are alsoa challenge for the surgeon from the aspect of repeated operations on account of relapses andsometimes also because they threaten the patient’s life.The authors operated in 1996-2000 at the Paediatric ENT Clinic and the Paediatric Surgical Clinic(Paediatric Faculty Hospital with Policlinic and Medical Faculty Comenius University Bratislava)14 children from a group of 16 patients with lymphangioma of the head and neck.The lymphangiomas were in 69% of the patients on the neck and in 31% on the head (tab. 1). Onechild had a lymphangioma on the head, neck and chest. The ratio of boys: girls was 1.3:1 (tab. 2). Themean age of the patients at the time of hospitalization was 6.6 years. Five children were operatedon account of lymphangiomas originally in other departments and because of relapse were referredto the authors’ department. The authors made primary operations in 11 children.In seven children they made a total extirpation of the lymphangioma and in seven children, becauseof the closeness of the cyst wall and surrounding structures they left small tissue remnants on the carotid artery, n. hypoglossus and r. marginalis mandibulae n. facialis. They performed thusa subtotal extirpation of the tumor.Spontaneous regression of the lymphangioma occurred in one patient after treatment of sepsis andinfection in the lymphangioma and in another patient after prednisone treatment was started.In one 8-year-old with lymphangioma on the neck they decided to use conservative treatment withinterferon. After initial treatment with prednisone complete regression of the lymphangiomaoccurred. The patient is now four years without a relapse.In the discussion the authors deal with different types of lymphangiomas, the localizations reportedby different authors and their views on possible treatment.The authors consider surgery the only effective procedure in the treatment of lymphangiomas. Theeffect of prednisone on the regression of lymphangiomas remains open, although in some patientsit may be the method of choice.

Key words:
lymphangioma, treatment, children.