Percutaneous treatment of lymphatic malformations

• Published in: Otolaryngology-head and neck surgery 2009-08, Vol.141 (2), p.219-224
• Main Authors: Shiels, William E., Kang, D. Richard, Murakami, James W., Hogan, Mark J., Wiet, Gregory J.
• Format: Article
• Language: English
• Subjects: Administration, Cutaneous; Adolescent; Adult; Anti-Bacterial Agents - therapeutic use; Child; Child, Preschool; Cysts - drug therapy; Cysts - pathology; Doxycycline - therapeutic use; Drug Therapy, Combination; Ethanol - administration & dosage; Ethanol - therapeutic use; Female; Head - pathology; Humans; Infant; Infant, Newborn; Lymphatic Abnormalities - drug therapy; Lymphatic Abnormalities - pathology; Male; Middle Aged; Neck - pathology; Recurrence; Retrospective Studies; Risk Assessment; Sclerosing Solutions - administration & dosage; Sclerosing Solutions - therapeutic use; Sclerotherapy - methods; Severity of Illness Index; Sodium Tetradecyl Sulfate - administration & dosage; Sodium Tetradecyl Sulfate - therapeutic use; Treatment Outcome
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1016/j.otohns.2009.04.001

The aim of this study is to investigate a new treatment regimen for macrocystic and microcystic lymphatic malformations (LM) of the head and neck. The study represents a retrospective review of outcomes from new percutaneous treatments for lymphatic malformations. Thirty-one patients (age range, 2 days to 51 years of age) underwent percutaneous treatment for LM of the head and neck from 2001 to 2007. The LM involved the orbit, ear, parotid gland, face, and neck. Twenty-seven patients underwent primary treatment of LM; 4 were treated for recurrence after operative resection. Macrocysts (≥1 cm) were treated with dual-drug chemoablation (sequential intracystic sodium tetradecyl sulfate and ethanol); doxycycline was used for microcysts. Macrocysts and microcysts were treated after complete cyst aspiration with sonographic guidance. Fifty-four macrocysts and 125 microcysts were treated. The goal of treatment was complete cyst ablation documented by sonography or MR imaging. Mean number of treatments was 1.7 per patient; mean number of treatments for macrocysts was 1.1; mean treatments for microcysts was 1.7. Ablation efficacy was 179 of 179 (100%) cysts. Effective cyst ablation achieved effective clinical control with resolution of the external mass appearance. Treatments included massive head and neck mixed LM and cysts surrounding the facial nerve and brachial plexus. Infection occurred in 2 (6%) of 31 patients. No patient experienced postprocedural pain, skin necrosis, neuropathy, skin retraction, or myoglobinuria. Percutaneous sclerotherapy provides effective treatment for macrocystic and microcystic LM as primary treatment or for recurrence after surgical resection.