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. 2025 Jun 7;17(6):e85542.
doi: 10.7759/cureus.85542. eCollection 2025 Jun.

Large Cystic Lymphangiomas of the Neck: A Surgical Challenge

Pavithra Subramaniyan  1 , S M Azeem Mohiyuddin  2 , Divya N Jyothi  3 , Sagayaraj A  2 , Kouser Mohammadi  1 , Krishnappa J  4 , Sujatha Munireddy Papireddy  5 , Adarsh A D  6
Affiliations

Large Cystic Lymphangiomas of the Neck: A Surgical Challenge

Pavithra Subramaniyan et al. Cureus. .

Abstract

Background: Cystic hygroma, a congenital malformation of the lymphatic system, predominantly affects pediatric populations but can also present in adults, posing unique diagnostic and therapeutic challenges. This study aims to document the clinical and radiological extent and involvement of important neurovascular structures and also the outcome of patients treated for large cystic hygroma in the head and neck region.

Methods: A retrospective analysis of medical records was conducted for all 33 patients who underwent surgical excision of large cystic hygromas in our hospital. The data collected included patient age, sex, lesion location, anatomical stage (using the de Serres classification), morphological type (cavernous or macrocytic), surgical outcomes, postoperative complications, and recurrences.

Results: The study population comprised 22 (66.7%) pediatric patients (<18 years), with a 21 (63.6%) male predominance. According to the de Serres classification, 24 (72.7%) patients presented with stage III disease, involving both the suprahyoid and infrahyoid regions. Morphologically, lesions of 19 (57.5%) patients were cavernous, while 14 (42.4%) were macrocystic. Complete surgical excision was achieved in all patients. Postoperative complications occurred in eight (24.24%) patients, including transient injury to the marginal mandibular branch of the facial nerve in three (9.09%) patients and transient paralysis of the facial nerve in one (3.03%) patient. Recurrence was seen in four (12.12%) patients.

Conclusion: Cystic hygromas are congenital lymphatic malformations frequently involving the head and neck. Surgical excision remains the mainstay of treatment for large lesions, though it poses technical challenges due to proximity to vital neurovascular structures. With meticulous dissection, complications can be minimized. Sclerotherapy is effective for smaller lesions but is less suitable for extensive disease. Recurrence is uncommon following complete surgical excision.

Keywords: cystic hygroma; de serres classification; lymphangiomas; postoperative complications; recurrence; surgical excision.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Central Ethics Committee of Sri Devaraj Urs Academy of Higher Education and Research issued approval SDUAHER/KLR/R&D/CEC/S/PG/90/2024-25. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preoperative clinical image of cystic hygroma in a pediatric patient
This image shows a child presenting with a large, soft, non-tender, cystic swelling involving the left lateral aspect of neck, consistent with cystic hygroma.
Figure 2
Figure 2. Surgical scar in the neck
This image shows a lateral profile of a pediatric patient demonstrating a linear postoperative scar over the left side of the neck following the complete surgical excision of cystic hygroma.
See this image and copyright information in PMC

References

    1. Cervical cystic hygroma. Guruprasad Y, Chauhan DS. J Maxillofac Oral Surg. 2012;11:333–336. - PMC - PubMed
    1. Cystic hygroma of the neck: a case report and review of literature. Omisakin OO, Ayuba GI, Kache SA. https://www.alliedacademies.org/articles/cystic-hygroma-of-the-neck-a-ca... Online J Otolaryngol. 2021;11
    1. Surgical excision: an effective initial therapeutic option in the management of giant macrocystic lymphatic malformations in children. Hassan MA, Gatea HK, Ja'afar TK. Ann Pediatr Surg. 2020;16
    1. Late-onset presentation of orbital lymphangioma. Bailey ST, Wojno TH, Shields CL, Grossniklaus HE. Ophthalmic Plast Reconstr Surg. 2007;23:100–103. - PubMed
    1. Seyi-Olajide JO, Caouette-Laberge L, Ameh EA, Laberge JM. Pediatric Surgery. Cham: Springer International Publishing; 2020. Lymphangiomas; pp. 1177–1194.

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