LYMPHATIC MALFORMATIONS OF THE HEAD AND NECK - A PROPOSAL FOR STAGING

Objective: To propose a staging system for patients with lymphatic mal formations of the head and neck. Design: Retrospective chart review. P atients: Fifty-six patients were treated for lymphatic malformations f rom 1983 to 1993 at Children's Hospital and Medical Center, Seattle, W ash. The charts were reviewed for anatomic location of the lesion, pre operative and postoperative complications, number of procedures to con trol disease, long-term sequelae, and persistence of disease. Lesions were characterized as being unilateral or bilateral and suprahyoid and /or infrahyoid. The five patient groups were then compared with respec t to the above categories. Results: Preoperative complications reviewe d include preoperative infection, respiratory embarassment necessitati ng airway intervention, and feeding difficulties. Postoperative compli cations assessed were cranial nerve injury, wound infection, and serom a formation. Long-term sequelae included malocclusion, speech delay, a nd cosmetic deformity. The rate of persistent disease was also assesse d. A staging system was developed based on a progression of extent of disease. Stage I patients (n=12) had unilateral infrahyoid disease and a 17% incidence of complications overall. Stage II patients (n=17) ha d unilateral suprahyoid disease and a 41% incidence of complications. Stage III patients (n=15) had unilateral suprahyoid and infrahyoid dis ease and a complication rate of 67%. Stage IV patients (n=5) with bila teral suprahyoid disease had a complication rate of 80%, while stage V patients (n=6) with bilateral suprahyoid and infrahyoid disease had a 100% incidence of complications. Conclusion: Anatomic location of lym phatic malformations of the head and neck can be used to predict progn osis and outcome of surgical intervention.