CYSTIC HYGROMA OF THE NECK - CURRENT KNOW LEDGE AND MANAGEMENT

Cystic hygroma of the neck (CHN) is the result of a defect in the embr yonary development of the lymphatic system. In many cases foetal ultra sound allows an early diagnosis before birth, the prognosis being very different according to the gestational age at the time of detection. When discovered before 30 weeks of gestation it is almost always assoc iated with chromosomal abnormality and/or polymalformation leading to spontaneous or therapeutic abortion. On the contrary when appearing af ter the 30th week of gestation, CHN is usually an isolated malformatio n as when discovered during infancy or childhood. Approximately 2.3 of these ''late'' CHN are present at birth; 90% are discovered before 2 years of age. A spontaneous regression occurs in about 15% of the case s. In 70% of cases the CHN is simple without extension to the orophary nx or mediastinum and its complete surgical resection is usually easy. Extension to the oropharynx is present in about 20% of the cases; the re is a risk of neonatal respiratory distress and the treatment is dif ficult. Extension to the mediastinum is found in about 10% of the case s; respiratory distress is rare and a large surgical resection is nece ssary. Surgery is the primary treatment of CHN after a careful evaluat ion of the extension of the tumor by ultrasound, scannography or nucle ar magnetic resonnance, and oropharyngeal endoscopy. It allows a ''mac roscopically complete'' resection in about 80% of the cases, but a rec urrence is observed in approximately one every five cases. Following p artial resection or important recurrence, treatment includes according to the cases: new attempt of surgical resection, sclerosing therapy, and laser therapy for the oropharyngeal forms.