Diagnosis and surgical treatment of cervical macrocystic lymphatic malformations in infants

Abstract

The treatment of lymphatic malformations (LMs) represents a great clinical challenge. The present study reported on the treatment of 68 infants with cervical macrocystic LMs using surgical resection. The cases were retrospectively analyzed. All patients underwent pre-operative ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) examinations. The surgery was performed under general anesthesia with endotracheal intubation. Ultrasonograms showed that 24 cases were monolocular, 44 were multilocular, 16 had no echo, 20 had a uniform low-level echo and 32 had a non-uniform low-level echo. CT showed non-enhancing low-attenuating cystic lesions and attenuation values of 10–45 HU. The magnetic resonance images of the LMs showed a low signal intensity on T1-weighted imaging (WI) and a high signal intensity on T2-WI. Complete resection was achieved in 56 patients, subtotal resection in eight and partial resection in four. Two complications were noted, including reversible paresis of the marginal mandibular branch of the facial nerve and a surgical-site infection. One patient in whom partial resection was achieved had recurrence at ~2 months after the surgery. Ultrasonography, CT and MRI clearly demonstrated the size, shape, extent and adjacent structures of LMs, which aided in surgical planning and assessment of potential risks. Surgical excision increased the chances of cure and was relatively safe for infants aged <1 year. Location and extent, rather than age, were determined to be the most important factors for successful surgical treatment.

Surgical excision: an effective initial therapeutic option in the management of giant macrocystic lymphatic malformations in children

“…Painless mass was the mode of presentation in the majority (66.7%) of patients in this study. Similar findings were reported in previous relevant series [7,8].…”

“…Asymptomatic mass with parental esthetic concern is the usual presentation of macrocystic lymphatic malformations in infants and children. Even when large, these lesions may not cause symptoms as they grow within an overlying elastic skin and subcutaneous tissue especially in the cervicofacial region where these lesions predominate [7]. Painless mass was the mode of presentation in the majority (66.7%) of patients in this study.…”

“…Residual lesion was recorded in only one patient with a giant lesion involving both sides of the neck with sublingual extension. Ma et al and Chen et al reported complete surgical resection in 82.4% and 89.4% of their case series respectively [7,8].…”

“…Lymphatic malformations are rare benign tumors that stem from a malformation of the lymphatic vessels in the soft tissues and account for 5-6% of all benign soft tissue tumors in children [1,5,7]. The majority (75%) of these lesions develop in the cervicofacial region and the diagnosis can be done before the age of 2 years in 90% of the cases [3,4].…”

“…The majority (75%) of these lesions develop in the cervicofacial region and the diagnosis can be done before the age of 2 years in 90% of the cases [3,4]. No significant sexual or racial differences have been reported regarding the incidence of LMs [7]. In this study, 66.7% of the patients had their lesions in the neck, 77.8% of the patients were presented before the age of 2 years, and the male to female ratio was 1:0.8.…”