[Diagnosis and surgical treatment of cervical lymphangioma]

Abstract

Objective: To discuss the methods of surgical treatment and their timing choices of cervical lymphangioma.

Methods: A retrospective review of 53 patients with cervicofacial lymphangioma were treated surgically from July 1990 to December 2008. The age at operation was from 6.5 months to 41 years old (median age was 2 years old and 3 months). Eighteen (34.0%) lesions were located in the suprahyoid region and 35 (66.0%) lesions in the infrahyoid region. The diameter of lesion ranged from 3.3 to 8.2 cm (average: 4.4 cm). Neck mass was the sole symptom for 77.4% (41/53) cases. Nine patients presented with life-threatening complications including intracystic hemorrhage in 2 cases/times, infection and rapid increase in tumor size in 5 cases/times, dysphagia in 2 cases/times and respiratory obstruction in 4 cases/times. Color Doppler ultrasound was used to diagnose all patients pre-operatively. Computed tomography (CT) was used in 11 cases and magnetic resonance imaging (MRI) in 21 cases for differential diagnosis.

Results: The patients were treated by complete resection in 34 cases and subtotal resection in 8 cases. But partial resection in 11 (20.8%) cases developed a residual or recurrent lesion within 9 months to 5 years post-operation, including 7 cases in suprahyoid region and 4 cases in infrahyoid region. The rate of residual or recurrent lesions was significantly higher in the suprahyoid region (7/18) than that in the infrahyoid region (4/35) (chi(2) test, P < 0.05). The peri-operative complications were paralyses of mandibular branch of facial nerve, Horner's syndrome, secondary hemorrhage, fluid collection at resection site, local infection and parotid fistula in 1 case respectively. Respiratory distress caused by edema of tongue was present in 2 cases. All of them were cured conservatively. The pathological diagnosis was confirmed as capillary lymphangioma in 19 cases and cystic lymphangioma in 34 cases.

Conclusion: The localization and extent of cervical lymphangioma are the most important determining factors for a successful surgical resection. Although complete excision is the ideal treatment for cervicofacial lymphangioma, this should not be attempted if lesions are too large and neighboring structures liable to injury. The surgeons should be aware of the limitations and potential surgical complications in certain instances.