Nonsurgical therapies for lymphangiomas: A systematic review
Presented at the Annual Meeting of the American Academy of Otolaryngology–Head and Neck Surgery, Washington, DC, September 16-19, 2007.
Received 28 August 2007; received in revised form 17 October 2007; accepted 15 November 2007.
Objective
Systematically review the published literature regarding the efficacy of nonsurgical therapies in the treatment of head and neck (H&N) lymphatic malformations (LM) in children.
Data Source
MEDLINE.
Review Methods
MEDLINE was searched for literature relating to nonsurgical treatments for H&N LM.
Results
The initial search returned 1876 articles, with 22 meeting criteria. The majority (20) were case series. All therapies were percutaneous, with OK-432 or bleomycin sclerotherapy being most common. Random-effects modeling revealed 43% (CI = 28.9%-57%) of patients undergoing OK-432 for LM achieved a complete/excellent response, 23.5% (CI = 5.8%-41.3%) achieved a good response, 16.9% (CI = 10.3%-23.4%) achieved a fair/poor response, and 15.4% (CI = 8.6%-22.2%) observed no response. In the bleomycin group, the results were: 35.2% (CI = 15.7%-54.6%) excellent, 37.1% (CI = 22%-52.3%) good, 18.4% (CI = 2.7%-34.2%) fair/poor, and 11.6% (CI = 3.5%-19.6%) no response. Seven major complications were noted out of the 289 patients in the series, including two mortalities.
Conclusions
The literature indicates that sclerotherapy for H&N LM achieves excellent/good clinical response in a majority of patients, with few complications, and anecdotally does not complicate future surgery.
aDepartment of Otolaryngology–Head and Neck Surgery, Walter Reed Army Medical Center, Washington, DC
bDivision of Otolaryngology, Children’s National Medical Center, Washington, DC.
Corresponding author: Rahul K. Shah, MD, FAAP, Division of Otolaryngology, Children’s National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010.
ABSTRACT