| Abstrakt: |
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 [ABSTRACT FROM AUTHOR] |
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