Multimodality Treatment of Pediatric Lymphatic Malformations of the Head and Neck Using Surgery and Sclerotherapy
| Autor: | Benjamin E. J. Hartley, Simone J. Boardman, Martin J. Elliott, L.A. Cochrane, Derek J. Roebuck |
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| Rok vydání: | 2010 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Zein medicine.medical_treatment Antineoplastic Agents Disease Diatrizoate Electrocoagulation Picibanil Postoperative Complications Sclerotherapy medicine Humans Combined Modality Therapy Cyst Child Ultrasonography Interventional Retrospective Studies Lymphatic Abnormalities medicine.diagnostic_test business.industry Fatty Acids Infant Newborn Infant Magnetic resonance imaging Retrospective cohort study General Medicine medicine.disease Sclerosing Solutions Surgery Drug Combinations Otorhinolaryngology El Niño Propylene Glycols Child Preschool Retreatment Female Laser Therapy business |
| Zdroj: | Archives of Otolaryngology–Head & Neck Surgery. 136:270 |
| ISSN: | 0886-4470 |
| DOI: | 10.1001/archoto.2010.6 |
| Popis: | Objectives To describe a multimodality approach to the management of pediatric head and neck lymphatic malformations using surgery, sclerotherapy, or both and to review the outcomes of these approaches. Design Retrospective case series. Setting A single pediatric tertiary care referral center. Patients Ninety-seven pediatric patients (aged 1 month to 16 years) diagnosed as having lymphatic malformations of the head and neck during a 7-year period. Follow-up ranged from 3 months to 7 years. Interventions All of the patients underwent clinical and radiologic (magnetic resonance imaging) assessment. Treatment modality was selected according to disease location, cyst size, and parental preference. Treatments included surgery (open excision, tongue reduction, electrocautery, and laser treatment), sclerotherapy with OK-432 (Picibanil) or a fibrosing agent (Ethibloc), and a combination of modalities. Main Outcome Measures Clinically determined responses to treatment, complications, and number of treatments required. Results All isolated neck disease had complete or near-complete responses, with no nerve palsies sustained. Although most patients achieved complete or near-complete responses, disease with parotid, laryngopharyngeal, or oral components had poorer outcomes and frequently required multiple treatments. Significant long-term neural injury was sustained in 3 of 6 surgical patients for mediastinal disease and in only 4% (n = 4) of other surgical procedures. Conclusions Surgery retains an important role in the treatment of pediatric head and neck lymphatic malformations despite the advent of sclerotherapy. Isolated neck disease has an excellent outcome with either modality. Treatment decisions were made via a problem-based approach and were individualized according to anatomical location and disease classification. |
| Databáze: | OpenAIRE |
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