Sclerotherapy combined with sirolimus for the treatment of complex cervicofacial lymphatic malformations in infants: avoiding the need for tracheostomy.

BACKGROUND

Lymphatic malformations (LMs) are low-flow, congenital lesions commonly presenting as asymptomatic masses in the head and neck. However, large lymphangiomas can significantly affect breathing or swallowing, posing considerable treatment challenges.

METHODS

A retrospective analysis of complex cervicofacial LMs in infants was conducted over the past 8 years at the Department of Radiology. Patients were included if they had complex cervicofacial LMs. The size and type of LMs were assessed using ultrasound or MRI. All patients underwent sclerotherapy combined with sirolimus treatment. Treatment outcomes were evaluated through clinical examination and imaging findings.

RESULTS

Nineteen infants with large and extensive LMs of the head and neck were identified, including 12 males and 7 females. Thirteen patients had macrocystic lesions, five had mixed lesions, and one had microcystic lesions. Posttreatment, 18 children showed a size reduction of more than 75%, and one case demonstrated a reduction of 51-75%. Mild-to-moderate fever was observed in four cases postoperatively, and two cases experienced localized swelling. None of the 19 cases developed serious adverse reactions, such as allergies, pulmonary fibrosis, nerve injury, or skin necrosis.

CONCLUSIONS

Sclerotherapy combined with sirolimus appears to be a safe and effective treatment for complex cervicofacial LMs in infants. This approach reduced the necessity for tracheotomy in affected children.