Total, subtotal, and partial surgical removal of cervicofacial lymphangiomas

Objectives: To compare different surgical interventions for the treatment o f extensive cervicofacial lymphangiomas and to define the minimal extent of surgery necessary to control disease. Design: Retrospective study. Mean +/- SD follow-up was 31 +/- 4 months afte r surgery. Surgical procedures were grouped as follows: (1) total removal, (2) subtotal removal (all cystic structures removed, small plaques of cyst walls left attached to vital structures), (3) partial removal (major cysts removed, some partially resected cystic structures left in place), and (4) incision and aspiration with subsequent compression bandage. Control of dis ease was defined as no recurrent or residual tumor or as recurrent or resid ual tumor less than 10% of initial tumor size without evidence of growth on several postoperative examinations and without clinical symptoms or aesthe tic disfigurement. Patients: Twenty-one patients with cervicofacial lymphangiomas (>3 cm in ma ximum diameter) without thoracic involvement were evaluated. Fifteen patien ts were 6 years or younger and 6 were older than 6 years. No surgery was ye t performed in 3 patients, for a total of 24 surgical interventions in 18 p atients. Setting: Hospitalized care in 2 referral centers. Results: After total removal, disease was controlled in 5 of 5 cases; after subtotal removal, in 8 of 9 cases; after partial removal, in 1 of 7 cases; and after incision and aspiration with subsequent compression bandage, in 0 of 3 cases. Two complications were encountered-1 fully reversible paresis of the marginal branch of the facial nerve and 1 secondary healing. Conclusions: Surgical removal of cervicofacial lymphangiomas is a safe trea tment modality. Disease control can be achieved if all cystic structures ar e removed. Small plaques of cyst walls attached to vital structures may be left in place. If small cystic extensions of lymphangiomas are only opened and left in place or if lymphangiomas are only drained following compressio n bandage, symptomatic residual tumor or recurrence is frequent.