In:
The Laryngoscope, Wiley, Vol. 131, No. 6 ( 2021-06), p. 1392-1397
Abstract:
An increasing number of treatment modalities for lymphatic malformations are being described, complicating therapeutic decisions. Understanding lymphatic malformation natural history is essential. We describe management of head and neck lymphatic malformations where decisions primarily addressed lesion‐induced functional compromise (ie, breathing, swallowing) to identify factors associated with invasive treatment and active observation. We hypothesize that non‐function threatening malformations can be observed. Study Design Retrospective case series. Methods Retrospective case series of consecutive head and neck lymphatic malformation patients (2000–2017) with over 2 years of follow‐up. Patient characteristics were summarized and associations with invasive treatment (surgery or sclerotherapy) tested using Fisher's exact. In observed patients, factors associated with spontaneous regression were assessed with Fisher's exact test. Results Of 191 patients, 101 (53%) were male, 97 (51%) Caucasian, and 98 (51.3%) younger than 3 months. Malformations were de Serres I–III 167 (87%), or IV–V 24 (12%), and commonly located in the neck (101, 53%), or oral cavity (36, 19%). Initial treatments included observation (65, 34%) or invasive treatments such as primary surgery (80, 42%), staged surgery (25, 13%), or primary sclerotherapy (9, 5%). Of 65 initially observed malformations, 8 (12%) subsequently had invasive treatment, 36 (58%) had spontaneous regression, and 21 (32%) elected for no invasive therapy. Spontaneous regression was associated with location in the lateral neck ( P = .003) and macrocystic malformations ( P = .017). Conclusion Head and neck lymphatic malformation treatment selection can be individualized after stratifying by stage, presence of functional compromise, and consideration of natural history. Recognizing the spectrum of severity is essential in evaluating efficacy of emerging treatments, as selected malformations may respond to observation. Level of Evidence 4 Laryngoscope , 131:1392–1397, 2021
Type of Medium:
Online Resource
ISSN:
0023-852X
,
1531-4995
Language:
English
Publisher:
Wiley
Publication Date:
2021
detail.hit.zdb_id:
2026089-1
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