AESTHETIC CONSIDERATIONS IN EXTIRPATION OF MELOLABIAL LYMPHATIC MALFORMATIONS IN CHILDREN

Surgical treatment of lymphatic malformations in the nasolabial region of children has produced disappointing results. Attempts to remove th em through a preauricular incision have generally required a synchrono us superficial parotidectomy in an attempt to prevent facial nerve inj ury. However, incomplete removal with this approach is common, leading to multiple surgeries, infections, facial nerve injury, and when paro tidectomy is performed, a lateral facial concavity. To avoid these com plications and still extirpate the lymphatic malformation, an alternat ive direct external technique has been employed since 1986. A retrospe ctive review of nine children with melolabial lymphatic malformations so managed was undertaken to assess treatment outcome. All patients un derwent computed tomography (CT) or, more recently, magnetic resonance imaging (MRI) scans to define the anatomic limits of the lymphatic ma lformation and its relationship to the facial musculature. Scans diffe rentiated localized lesions (resectable) from diffuse lesions (unresec table). Al patients underwent direct external soft-tissue excisional d ebulking by means of melolabial incisions with perialar and/or supra-w hite roll extensions as needed. The mean age at time of surgery was 5. 6 years. Complications were considered minor: One patient developed a small hematoma for which no specific treatment was necessary; four pat ients required antibiotics for cellulitis. The mean age at follow-up w as 5.25 years. The mean number of procedures necessary to achieve fina l outcome was 3.25. The mean number of episodes of postoperative cellu litis was 1.8. There was a high level of patient and parent acceptance of facial scars. No patient required secondary scar revision. The ext ernal approach addresses the pathology directly, removes a greater ove rall percentage of abnormal tissue than the traditional hemirhytidecto my approach, and avoids potential injury to the facial nerve and the d eforming concavity resulting from parotidectomy.