PROGNOSTIC FACTORS IN THE TREATMENT OF LYMPHATIC MALFORMATIONS

Objective: To find factors that may influence the treatment outcomes o f lymphatic malformations of the head and neck in children. Design: Ch arts of patients treated surgically for lymphatic malformations of the head and neck between 1988 and 1996 at our tertiary care children's h ospital were reviewed retrospectively. Outcomes were correlated with a ge at presentation, associated symptoms, anatomical site (s) of involv ement, extent of disease, length of time between first symptoms and su rgery, completeness of removal, and histologic pattern. Patients: Of 8 5 children treated, 74 underwent primary surgical excision at our hosp ital. Follow-up ranged from 6 months to 8 years, with a mean of 3 year s.Results: The overall recurrence rate, judged by functional or cosmet ic deformity, was 22%. Two neonates died of the disease. Factors assoc iated with a better prognosis were a single anatomical site of involve ment; location in the neck, even if involving 2 sites; and the impress ion of completeness of resection at the time of surgery. Findings asso ciated with a higher recurrence rate included younger age (especially neonates) and the presence of associated symptoms (ie, infection, dysp nea, dysphagia, and hemorrhage). The histologic pattern and the length of time from diagnosis to treatment were not significantly associated with the prognosis. Conclusions: We recommend aggressive, timely sur ib cal excision for lymphatic malformations of the head and neck. The timing of surgery should be based on the child's functional and cosmet ic deformity at the time of presentation and on the likelihood of comp lete excision, weighed against the morbidity associated with surgical excision.