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. 2023 Apr;133(4):956-962.
doi: 10.1002/lary.30237. Epub 2022 Jun 3.

Delaying Invasive Treatment in Unilateral Head and Neck Lymphatic Malformation Improves Outcomes

Juliana Bonilla-Velez  1   2   3 , Kathryn B Whitlock  1   3 , Sheila Ganti  1   3 , Giri M Shivaram  3   4 , Randall A Bly  1   2   3 , John P Dahl  1   2   3 , Scott C Manning  1   2   3 , Jonathan A Perkins  1   2   3
Affiliations

Delaying Invasive Treatment in Unilateral Head and Neck Lymphatic Malformation Improves Outcomes

Juliana Bonilla-Velez et al. Laryngoscope. 2023 Apr.

Abstract

Objectives: Large (De Serres stage [IV-V]) head and neck lymphatic malformations (HNLMs) often have multiple, high-risk, invasive treatments (ITs) to address functional compromise. Logically reducing HNLM ITs should reduce treatment risk. We tested whether delaying HNLM ITs reduces total IT number.

Materials: Consecutive HNLM patients (n = 199) between 2010 and 2017, aged 0-18 years.

Methods: ITs (surgery or sclerotherapy) were offered for persistent or dysfunction causing HNLMs. Treatment effectiveness categorized by IT number: optimal (0-1), acceptable (2-5), or suboptimal (>5). Clinical data were summarized, and outcome associations tested (χ2 ). Relative risk (RR) with a Poisson working model tested whether HNLM observation or IT delay (>6 months post-diagnosis) predicts treatment success (i.e., ≤1 IT).

Results: Median age at HNLM diagnosis was 1.3 months (interquartile range [IQR] 0-45 m) with 107/199(54%) male. HNLM were stage I-III (174 [88%]), IV-V (25 [13%]). Initial treatment was observation (70 [35%]), invasive (129 [65%]). Treatment outcomes were optimal (137 [69%]), acceptable (36 [18%]), and suboptimal (26 [13%]). Suboptimal outcome associations: EXIT procedure, stage IV-V, oral location, and tracheotomy (p < 0.001). Stage I-III HNLMs were initially observed compared with stage I-III having ITs within 6 months of HNLM diagnosis, had a 82% lower relative treatment failure risk ([i.e., >1 IT], RR = 0.09, 95% CI 0.02-0.36, p < 0.001). Stage I-III HNLMs with non-delayed ITs had reduced treatment failure risk compared with IV-V (RR = 0.47, 95% CI 0.33-0.66, p < 0.001).

Conclusion: Observation and delayed IT in stage I-III HNLM ("Grade 1") is safe and reduces IT (i.e., ≤1 IT). Stage IV-V HNLMs ("Grade 2") with early IT have a greater risk of multiple ITs.

Level of evidence: 4 Laryngoscope, 133:956-962, 2023.

Keywords: head and neck; lymphatic abnormalities; lymphatic malformation; observation; sclerotherapy; surgery; treatment.

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References

BIBLIOGRAPHY

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