Multistage Sclerotherapy for Extensive Lymphatic Malformations with Airway Involvement in Infant: A Protocol to Prevent Tracheotomy

• Published in: Journal of oral and maxillofacial surgery Vol. 75; no. 9; pp. 1882 - 1890
• Main Authors: Chen, An-Wei, MD, Wang, Tao, MD, Huang, Ying-Ying, MD, Liu, Shao-Hua, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017
• Subjects: Airway Obstruction - etiology; Airway Obstruction - therapy; Anesthetics, Local - therapeutic use; Antibiotics, Antineoplastic - therapeutic use; Bleomycin - therapeutic use; Dentistry; Dexamethasone - therapeutic use; Drug Therapy, Combination; Female; Glucocorticoids - therapeutic use; Head - pathology; Humans; Infant; Infant, Newborn; Lidocaine - therapeutic use; Lymphatic Abnormalities - complications; Lymphatic Abnormalities - therapy; Magnetic Resonance Imaging; Male; Neck - pathology; Retrospective Studies; Sclerosing Solutions - therapeutic use; Sclerotherapy - methods; Surgery; Treatment Outcome
• ISSN: 0278-2391; 1531-5053
• DOI: 10.1016/j.joms.2017.03.006

Purpose The management of extensive head and neck lymphatic malformations (LMs) in infants is challenging because of life threatening upper airway compression. The aim of this study was to present a management protocol and evaluate the clinical outcomes for preventing tracheotomy in these patients. Materials and Methods Fifteen infants with extensive head and neck LMs and airway involvement were enrolled between August 2010 and September 2015 in Qilu Hospital Shandong University. According to various key factors associated with airway compression of patients in the perioperative period, different types of anesthesia, treatment times, sclerosant concentrations and sclerotherapy protocol were used. Multistage sclerotherapy was performed with bleomycin A5. All patients were followed up at 1, 3, 6, and 12 months. More extended follow-up was offered if the patients had a residual lesion requiring supplementary sclerotherapy. Reviews on the site and size of the lesion, times and duration of treatments, therapeutic response, airway complications and conduction of tracheotomy were performed. Results Lesions of LMs in the head and neck were located on the floor of the mouth, tongue and neck. An overall average of five treatments was required; a lesion reduction of more than 50% of the volume was achieved in all patients. Regarding the efficacy, morphological resolution was achieved in 3 cases (20%, 3/15), and there was a significant response in 12 cases (80%, 12/15). Eight patients (53.3%, 8/15) with microcystic LMs demonstrated immediate swelling and had more serious upper airway symptoms than the preoperative status, and 2 patients (13.3%, 2/15) had feeding difficulty. No upper airway obstruction occurred and no tracheotomy was performed in the patients in this study. Conclusions Multistage sclerotherapy with bleomycin A5 is a safe and effective treatment for extensive head and neck LMs in infants with airway involvement. A routine perioperative protocol is essential for reducing airway complications.