Cystic hygroma of the head and neck - a long-term follow-up of 44 cases

Cystic hygroma of the neck is a relatively rare congenital malformation usu ally diagnosed during the first years of infancy. Complete surgical extirpa tion may be impossible without sacrificing important neurovascular structur es. This paper reports the long-term outcome of surgical treatment during a 35-year period. A follow-up examination of 44 patients (24 males and 20 fe males) treated in our departments during the last 35 years was performed. M edian age at first operation was 1.5 years (0-28 years) The observation per iod ranged between 1 and 36 years, median 16.2 years. Indications for opera tion were space occupying lesion, haemorrhage, dysphagia, difficulties in p ronounciation or breathing and infection or nerve lesions. Fifty percent of the patients revealed residual or recurrent hygroma at the time of follow- up. Forty-four percent suffered from impaired speech, food intake, breathin g or swallowing. Thirty-six percent were cosmetically bothered, and only 11 % reported reduced quality of life. A significant correlation was noted bet ween the extension of the lesion and (i) the number of operations performed and (ii) the rate of recurrent or residual hygroma. The rate of residual o r recurrent hygroma was statistically higher for the suprahyoid lesions com pared with the infrahyoid lesions. The localization and extent of the lesio n is related to the surgical outcome. Surgical intervention should be centr alized and should be considered carefully. Neurovascular structures should not be damaged in an attempt to effect complete removal. The above-mentione d results lead to a search for a new therapeutic modality, and the authors have recently taken up the Japanese way of treating hygromas by intralesion al injection of OK-432. The first two patients treated by this technique ha d total regression of the lesion, and the method seems to be promising as a n alternative to surgery.