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

Autor: Juliana Bonilla‐Velez, Kathryn B. Whitlock, Sheila Ganti, Giri M. Shivaram, Randall A. Bly, John P. Dahl, Scott C. Manning, Jonathan A. Perkins
Rok vydání: 2022
Předmět:
Zdroj: The Laryngoscope. 133:956-962
ISSN: 1531-4995
0023-852X
Popis: 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.Consecutive HNLM patients (n = 199) between 2010 and 2017, aged 0-18 years.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 (χMedian 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).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 4 Laryngoscope, 2022.
Databáze: OpenAIRE
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