Lymphatic malformations: Review of current treatment
Corresponding Author
Jonathan A. Perkins DO
Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
Corresponding author: Jonathan A. Perkins, DO, Seattle Children's Hospital, Division of Otolaryngology–Head and Neck Surgery, 4800 Sand Point Way N.E./Mailstop W-7729, Seattle, WA 98105-0371. E-mail address: [email protected]Search for more papers by this authorScott C. Manning MD
Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
Search for more papers by this authorRichard M. Tempero MD, PhD
Boys Town National Research Hospital, Omaha, NE
Search for more papers by this authorMichael J. Cunningham MD
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, MA
Search for more papers by this authorJoseph L. Edmonds Jr. MD, FAAP
Children's ENT of Houston, Houston, TX
Department of Otolaryngology and Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
Department of Otolaryngology, Weill Cornell College of Medicine, New York, NY
Department of Otolaryngology, University of Texas School of Medicine, Houston, TX
Search for more papers by this authorFredric A. Hoffer MD, FAAP, FSIR
Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA
Search for more papers by this authorMark A. Egbert DDS
Department of Oral and Maxillofacial Surgery, Dental Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA
Search for more papers by this authorCorresponding Author
Jonathan A. Perkins DO
Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
Corresponding author: Jonathan A. Perkins, DO, Seattle Children's Hospital, Division of Otolaryngology–Head and Neck Surgery, 4800 Sand Point Way N.E./Mailstop W-7729, Seattle, WA 98105-0371. E-mail address: [email protected]Search for more papers by this authorScott C. Manning MD
Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
Search for more papers by this authorRichard M. Tempero MD, PhD
Boys Town National Research Hospital, Omaha, NE
Search for more papers by this authorMichael J. Cunningham MD
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, MA
Search for more papers by this authorJoseph L. Edmonds Jr. MD, FAAP
Children's ENT of Houston, Houston, TX
Department of Otolaryngology and Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
Department of Otolaryngology, Weill Cornell College of Medicine, New York, NY
Department of Otolaryngology, University of Texas School of Medicine, Houston, TX
Search for more papers by this authorFredric A. Hoffer MD, FAAP, FSIR
Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA
Search for more papers by this authorMark A. Egbert DDS
Department of Oral and Maxillofacial Surgery, Dental Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA
Search for more papers by this authorSponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
This article is the result of a discussion at the American Society of Pediatric Otolaryngology Vascular Anomaly Task Force Head and Neck Lymphatic Malformation Symposium, September 17, 2007, Washington, DC.
Abstract
Objective
Summarize current knowledge of lymphatic malformation medical, sclerotherapy, and surgical treatment; and highlight areas of treatment controversy and treatment difficulty that need improvement.
Methods
Panel presentation of various aspects of lymphatic malformation treatment.
Results
The mainstay of lymphatic malformation treatment has been surgical resection, which has been refined through lesion staging and radiographic characterization. Intralesional sclerotherapy in macrocystic lymphatic malformations is effective. Suprahyoid microcystic lymphatic malformations are more difficult to treat than macrocystic lymphatic malformations in the infrahyoid and posterior cervical regions. Bilateral suprahyoid lymphatic malformations require staged treatment to prevent complications. Lymphatic malformation treatment planning is primarily determined by the presence or possibility of functional compromise. Problematic areas include chronic lymphatic malformation inflammation, dental health maintenance, macroglossia, airway obstruction, and dental malocclusion.
Conclusions
Lymphatic malformation treatment improvements have been made through radiographic characterization and staging of lymphatic malformations. Direct malformation involvement of the upper aerodigestive tract can cause significant functional compromise that is difficult to treat.
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