A huge high rising cervico-facial lymphangioma in an adolescent male: from pterygoid to hyoid

Abstract

<p class="abstract">Cervicofacial lymphangioma is a benign swelling of the neck and is commonly seen in paediatric population. Common sites of involvement are the submandibular space and the posterior triangle and rarely involves the face. We present a rare case of a huge cervico-facial lymphangioma in a 14 year old male where the swelling presented one year back and had progressively increased in size extending from the medial pterygoids and pterygomandibular space above to myelohyoid muscle below. Intraoperatively, it was closely abutting the submandibular gland mimicking salivary gland retention cyst and the facial artery was traversing through the mass. Complete surgical excision of the mass was performed along with removal of the ipsilateral submandibular gland. Salivary gland mucocele and cervicofacial lymphangioma were the two main differential diagnosis in our case. Intraoperative findings of macrocystic spaces with septations pointed towards a lymphangioma. Post operative histopathology confirmed it to be lymphangioma lined with endothelial cells. We concluded from this case that cervicofacial swellings in higher age groups should have lymphangiomas as differential diagnosis. As the swelling ascended up to the skull base, careful radiological assessment, meticulous surgical plan and cranio-caudal exposure from the zygomatic arch above to the hyoid below helped in complete surgical excision of the mass. </p>