Lymphatic Abnormalities(Cystic Hygromas)
What is a lymphangioma?
A lymphangioma is the result of an abnormal collection of lymph channels in the body. These channels usually link the disease-fighting lymph nodes together. During fetal development connections may occur causing cysts made up of these channels to grow. Large extensive collections of these are known as lymphangiomas or cystic hygromas. They grow steadily with the child and usually surround normal muscles, blood vessels, and nerves. These cysts can involve the neck, oral cavity, face and airway. They can also extend into the chest.
How are lymphangiomas recognized?
Because of their size, lymphangiomas are usually visible as a large compressible (can flatten when pushed on) mass. Those not noticed at birth are recognized before most children reach their second birthday.
Why are lymphangiomas of concern?
Lymphangiomas grow around normal muscles, blood vessels, and nerves. They may become quite extensive and cause significant cosmetic (appearance) deformities and functional disabilities. They may prevent the child from swallowing normally, speaking, or even breathing. The cysts are not cancerous. However, they continue to grow and many times cannot be completely removed without sacrificing an important normal structure.
How is a lymphangioma diagnosed and treated?
DIAGNOSIS: These lesions are first evaluated by physical examination. Magnetic Resonance imaging (MRI) is the imaging study that gives the best information regarding the extent and location of the cystic hygroma. X-rays and CT scans may also be used to help fully realize the extent of the cyst.
Once the location and extent into surrounding structures has been studied, therapy best suited for the patient can be initiated.
TREATMENT: There are generally two methods used to treat lymphangiomas:
Medical – This method utilizes medications (sclerosing agents) injected into the cyst to reduce the size of the cyst. This means that the cyst is not removed, but “scars” down on itself so that growth stops.
Surgical – This approach to treatment of a lymphangioma is excision of the cyst with a surgical procedure. *If airway involvement is present, the lymphangioma is removed as soon as it is diagnosed. Sometimes, a TRACHEOTOMY may be needed to secure the airway.
Our practice’s philosophy is to surgically remove those lesions that appear to be removable with a single operation. Many times this is done in the first few months of life. If, however, the lesion is quite extensive and places the child at risk for nerve, blood vessel, or muscle damage, or, would result in significant deformity in the appearance of the child, sclerosing agents are recommended.
What is a hemangioma?
A hemangioma is an abnormal growth of blood vessels that are formed before or shortly after birth. They can be very small (pinpoint) or grow to be quite large. They need to be distinguished from vascular malformations (abnormal connections between blood vessels) because treatment is different.
What do hemangiomas look like?
Hemangiomas may look like small red pimples on the skin, large bulging bluish-red masses protruding from the forehead or eyelid, or soft compressible bluish masses in the neck. Hemangiomas may also involve the breathing tube just below the voice box (subglottic area) causing noticeable breathing problems.
Hemangiomas usually start to grow larger shortly after birth (proliferative stage) reaching a peak at 18 months to 2 years of age. At that point, most hemangiomas will start to shrink (involute). This process may take several years.
How are hemangiomas diagnosed and treated?
DIAGNOSIS: Magnetic resonance imaging (MRI) is used to diagnose hemangiomas. Sometimes, a biopsy (a small amount of tissue from the lesion) is required to confirm the diagnosis.
TREATMENT: If hemangiomas are located in areas that cause the patient breathing problems (in the airway) or problems seeing (covers part of the eye), steroids may be given to shrink the mass. However, steroids only give temporary relief and therefore need to be given over long periods of time. In addition, this form of treatment has its own risks due to side effects of steroids. Should this treatment option be recommended, your physician will discuss these issues in detail with you.
If steroids are not advised, then surgical therapy is an alternative to remove or reduce the size of the hemangioma more permanently. Surgical therapy using laser has been very helpful in shrinking or excising (removing) hemangiomas.
Both the CO2 (carbon dioxide) and YAG laser are used in our practice.