Treatments and Outcomes of Pediatric Head and Neck Lymphatic Malformations: A 20-Year Single Institution Experience.

Objective: Examine the management and outcomes of pediatric head and neck lymphatic malformations (HNLMs).

Study design: Retrospective case series.

Setting: Tertiary academic hospital.

Methods: Patients aged 18 years or younger treated for HNLMs at Johns Hopkins Hospital from 2000 to 2023 were identified. Demographics, clinical characteristics, and treatment courses were recorded from charts. Outcome measures included estimated clinical post-treatment size reduction and complications. Fisher's exact test was performed for comparisons between treatments.

Results: We identified 101 pediatric patients (50.5% female) with HNLMs. Fifty-two received unimodal treatment, 11 received multimodal treatment, and 38 underwent active observation or no treatment. Of those who received treatment, 44% had their first treatment before 2 years of age. 54.5% of all patients received sclerotherapy. Sclerotherapy caused nearly complete or complete resolution in 52.2% (n = 24) of low-stage (de Serres Stages 1-3) HNLMs and complete resolution in 26.1%. Most (71.4%) high-stage (de Serres Stages 4-5) malformations demonstrated limited size reduction response to all treatments. Surgery had a higher all-inclusive complication rate (25%) compared to sclerotherapy (17%). Multimodal treatment strategies were most often used to treat microcystic malformations of all stages, achieving a 42.9% nearly complete or complete resolution rate.

Conclusion: Low-stage and macrocystic pediatric HNLMs respond well to treatment. Sclerotherapy had the lowest complication rate. High-stage malformations had limited size reduction response to multimodal treatment. As new medical therapies continue to develop, opportunities for improved treatment algorithms will emerge.