Sclerotherapy of cystic lymphangioma

ABSTRACT

Cystic lymphangioma is a congenital lymphatic malformation that occurs most commonly in the head and neck. Most lymphangiomas are asymptomatic, but progressive enlargement may cause feeding difficulty, airway, and cosmetic problems. According to the diameter of the majority of the cysts, lymphangiomas are divided into macrocystic (>1 cm), microcystic (<1cm), or mixed types. Sclerotherapy has been recommended as a primary treatment because surgery may result in severe tissue defect or functional complication. OK-432 is the most widely used sclerosant. Typical complications include fever, local inflammation, pain and swelling, which can usually be controlled conservatively. Bleomycin has potential risk of lung fibrosis, although there has been no such report in the literature. Acetic acid is a more potent sclerosant, which may be used as a secondary drug due to the risk of adjacent nerve damage in high concentration.The lesions are punctured with a 21 G needle under ultrasound guidance. In macrocystic lesions, we inserted 6-7 F catheters for drainage and instillation of sclerosant. While OK-432 and bleomycin are not removed, alcohol and acetic acid should be removed after indwelling for 20 minutes. Overall, an excellent response (over 90% resolution) rate of 48% was achieved. Response rate was higher in macrocystic type than microcystic type. There may be a risk of airway obstruction due to swelling and inflammation in cervical lesions. Preventive tracheostomy or intubation may be necessary in those lesions. In conclusion, sclerotherapy is a safe and effective for treatment of lymphangioma. It is recommended as a first line therapy.