Sclerotherapy for Benign Cystic Lesions of the Head and Neck: Systematic Review of 474 Cases

Abstract

Objective The role of sclerotherapy for vascular lesions of the head and neck is well established. However, the efficacy of sclerotherapy for benign cystic lesions of the head and neck is less clear. The objective of this review is to determine the efficacy and safety of sclerotherapy for benign cystic lesions of the head and neck. Data Sources PubMed/MEDLINE, Cochrane Library, and Embase. Review Methods The PRISMA guidelines (Preferred Reporting Systems for Systematic Reviews and Meta-analyses) were followed for this systematic review. Studies of patients with benign head and neck cystic masses treated primarily with sclerotherapy were included. Thirty-two studies met criteria for inclusion. Results A total of 474 cases of sclerotherapy were reviewed. Agents comprised OK-432, ethanol, doxycycline, tetracycline, and bleomycin. Lesions in the analysis were ranula, thyroglossal duct cyst, branchial cleft cyst, benign lymphoepithelial cyst, parotid cyst, thoracic duct cyst, and unspecified lateral neck cyst. A total of 287 patients (60.5%) had a complete response; 132 (27.9%) had a partial response; and 55 (11.6%) had no response. OK-432 was the most widely utilized agent, with a higher rate of complete response than that of ethanol (62.0% vs 39.4%, P = .015). Fifty-three cases (11.2%) required further surgical management. One case of laryngeal edema was reported and managed nonoperatively. Conclusion Sclerotherapy appears to be a safe and efficacious option for benign cystic lesions if malignancy is reliably excluded. Efficacy rates are comparable to those of sclerotherapy for vascular malformations. The rate of serious complications is low, with 1 incident of airway edema reported in the literature.

Ethanol Ablation of Ranulas and Risk Factor Analysis for Recurrence

“…However, recent randomized clinical trials and meta-analyses have shown that sclerotherapy with OK-432 is less effective for plunging than for simple ranulas, with complete response rates of 25% to 67% in plunging ranula. [20][21][22] Additionally, there are drawbacks to OK-432, such as a slow therapeutic response that takes more than 6 weeks after treatment; complications, including swelling, pain, erythema, and fever 23 ; and the need to perform skin tests to determine allergies to penicillin G. 7 In our study, 90% of the patients had plunging ranulas and demonstrated outcomes comparable with those treated with OK-432. Because ethanol is a more potent and cost-effective sclerosing agent and induces a faster therapeutic response than OK-432, 1 ethanol may be an effective and safe sclerosant that can replace OK-432 for treating ranula.…”

“…Therefore, we also evaluated the risk factors associated with subsequent surgery as a secondary outcome. Eleven of the 57 patients (19%) underwent subsequent surgery after recurrence, a percentage similar to that of patients with plunging ranulas treated with OK-432 (20.8%) . Although PPS extension was not significantly associated with subsequent surgery, possibly due to the limited number of patients with PPS extension (n = 12), it makes the effective aspiration of all mucus materials and even distribution of the effects of ethanol across surrounding connective tissue more challenging in clinical practice.…”

“…Eleven of the 57 patients (19%) underwent subsequent surgery after recurrence, a percentage similar to that of patients with plunging ranulas treated with OK-432 (20.8%). 22 Although PPS extension was not significantly associated with subsequent surgery, possibly due to the limited number of patients with PPS extension (n = 12), it makes the effective aspiration of all mucus materials and even distribution of the effects of ethanol across surrounding connective tissue more challenging in clinical practice. As the effectiveness of treatment for plunging ranulas depends on the complete sclerotherapy of the entire plunging tract, 1 EA may be less effective for larger ranulas.…”

Minimally Invasive Management of Neonatal Piriform Fossa Sinus Tract: A Scoping Review

“…A recent systematic review on the efficacy of sclerotherapy for benign cystic lesions of the head and neck reported complete and partial response rate of 60.5% and 27.9%, respectively. 14 It also noted that timing of sclerotherapy response was variable, with some changes occurring months after the initial injection. Moreover, the average patient needed approximately two sclerotherapy injections to achieve a response.…”

“…In view of the low overall patient number in this review, statistical analysis was not feasible to compare sclerotherapy versus only aspiration. A recent systematic review on the efficacy of sclerotherapy for benign cystic lesions of the head and neck reported complete and partial response rate of 60.5% and 27.9%, respectively 14 . It also noted that timing of sclerotherapy response was variable, with some changes occurring months after the initial injection.…”