Oral Lymphangiomas Follow-up

  • Author: Sean P Edwards, DDS, MD, FRCD(C); Chief Editor: William D James, MD   more...
 
Updated: Jan 18, 2012
 

Inpatient & Outpatient Medications

  • Perioperative antibiotic prophylaxis
    • Typically, prophylaxis with clindamycin 150-300 mg PO q6h to cover oral flora for 14 days is used after surgery involving larger, bulkier lesions.
    • Prophylaxis is not used in treating superficial lesions.
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Complications

  • The severity of the sequelae varies with the extent of the lesion.
  • Airway compromise is a possible complication.
    • Oral and hypopharyngeal lesions often result in a compromised airway. Approximately 50% of children with oral lymphangiomas require tracheotomy. Close cooperation between the surgeon and an anesthesiologist skilled in fiberoptic intubation is imperative.
    • The surgeon must be cognizant that these lesions may later expand and compromise the airway as a result of trauma, hemorrhage, infection, or upper respiratory tract infection. Surgeons should have a low threshold for performing a tracheostomy in patients in whom the potential for airway compromise exists.[13]
    • When a tracheostomy is not performed after a lesion on the tongue or floor of mouth has been debulked, the author prefers to manage the airway expectantly. The patient is left intubated overnight and reevaluated for extubation in the subsequent days.
  • Dental caries are proportionately prevalent in these patients with oral lymphangiomas and are most likely a result of patient's and dentist's difficulties in maintaining adequate oral hygiene. The finding of dental caries is important because the spread of odontogenic infection to a lymphatic malformation is potentially life threatening. Additionally, the premature loss of dentition can further hamper proper nutrition in an already compromised patient. Therefore, aggressive dental care and meticulous hygiene are warranted. Pediatric dentists should be involved early in the care of children with oral lymphangioma.
  • Dysmorphogenesis of the maxillofacial skeleton is frequently observed in association with oral and cervicofacial malformations.
    • The proposed etiologies for these changes include local pressure effects, increased blood flow, and direct bony involvement. Bony changes appear to progress until growth is complete, regardless of whether the soft-tissue lesions are treated. In other words, soft-tissue debulking does not appear to affect the progression of this deformity; this finding appears to support the direct bony involvement hypothesis because debulking eliminates local pressure and blood flow effects. In addition, the bony overgrowth appears to behave as a malformation, mirroring somatic growth trends.
    • Although no histologic evidence suggests the presence of lymphatics in the long bones, lymphatics appear to be present in the alveolar bone of the mandible and maxilla. Histologic examination of resected mandibular specimens reveals abnormal dilated channels in marrow spaces lined by a flat, adult-type endothelium; this observation further supports the direct bony involvement hypothesis.
  • Speech pathologies are common. These may result from abnormal morphology and mobility of the tongue, poor oral compliance, lip incompetence, and palatal hypomobility. Palatal hypomobility may contribute to eustachian tube dysfunction with resultant ear infections and conductive hearing deficits.
  • Feeding difficulties are common in neonates. Alternate enteral feeding routes, including a gastrostomy, are often necessary.
  • Repeated paroxysms of bleeding may occur secondary to trauma. These repeated paroxysms can be nuisances with superficial lesions, they can be life threatening with the expansion of deep lesions. Because the lesion is not lethal as long as airway compromise is avoided, the reported surgical mortality rates are 2.5-11.4%.
  • Complications can result from surgical treatment.
  • Complication rates of surgical debulking are typically 20-30%. Complications include airway obstruction, seromas and hematomas, infections, and cranial nerve palsies. Reported surgical mortality rates are 2.5-11.4%.
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Contributor Information and Disclosures
Author

Sean P Edwards, DDS, MD, FRCD(C)  Assistant Professor, Chief of Pediatric Oral and Maxillofacial Surgery, Section of Oral and Maxillofacial Surgery, Department of Surgery, C S Mott Children's Hospital, University of Michigan Medical Center

Sean P Edwards, DDS, MD, FRCD(C) is a member of the following medical societies: Alpha Omega Alpha, American Association of Oral and Maxillofacial Surgeons, American Cleft Palate/Craniofacial Association, American Medical Association, International Association of Oral & Maxillofacial Surgeons, and Royal College of Dentists of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Joseph Helman, DMD  Clinical Professor and Chair, Department of Oral and Maxillofacial Surgery, University of Michigan

Joseph Helman, DMD is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Smeena Khan, MD  Private Practice, Adult and Pediatric Dermatology Associates

Smeena Khan, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS  Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

  1. Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg. Mar 1982;69(3):412-22. [Medline].

  2. Padwa BL, Hayward PG, Ferraro NF, Mulliken JB. Cervicofacial lymphatic malformation: clinical course, surgical intervention, and pathogenesis of skeletal hypertrophy. Plast Reconstr Surg. May 1995;95(6):951-60. [Medline].

  3. Tempero RM, Hannibal M, Finn LS, Manning SC, Cunningham ML, Perkins JA. Lymphocytopenia in children with lymphatic malformation. Arch Otolaryngol Head Neck Surg. Jan 2006;132(1):93-7. [Medline].

  4. Alqahtani A, Nguyen LT, Flageole H, Shaw K, Laberge JM. 25 years' experience with lymphangiomas in children. J Pediatr Surg. Jul 1999;34(7):1164-8. [Medline].

  5. Yonetsu K, Nakayama E, Kawazu T, Kanda S, Ozeki S, Shinohara M. Value of contrast-enhanced magnetic resonance imaging in differentiation of hemangiomas from lymphangiomas in the oral and maxillofacial region. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Oct 1999;88(4):496-500. [Medline].

  6. Puricelli E, Ponzoni D, De Paris MF, de Abreu MC, Togni L. Surgical treatment of tongue lymphangioma in a pediatric patient: a case report. J Dent Child (Chic). Jul 2011;78(2):120-3. [Medline].

  7. Bonet-Coloma C, Minguez-Martínez I, Aloy-Prósper A, Rubio-Serrano M, Peñarrocha-Diago MA, Peñarrocha-Diago M. Clinical characteristics, treatment, and evolution in 14 cases of pediatric orofacial lymphangioma. J Oral Maxillofac Surg. Jun 2011;69(6):e96-9. [Medline].

  8. Raveh E, de Jong AL, Taylor GP, Forte V. Prognostic factors in the treatment of lymphatic malformations. Arch Otolaryngol Head Neck Surg. Oct 1997;123(10):1061-5. [Medline].

  9. Aciole GT, Aciole JM, Soares LG, Santos NR, Santos JN, Pinheiro AL. Surgical treatment of oral lymphangiomas with CO2 laser: report of two uncommon cases. Braz Dent J. 2010;21(4):365-9. [Medline].

  10. Bai Y, Jia J, Huang XX, Alsharif MJ, Zhao JH, Zhao YF. Sclerotherapy of microcystic lymphatic malformations in oral and facial regions. J Oral Maxillofac Surg. Feb 2009;67(2):251-6. [Medline].

  11. Burrows PE, Mitri RK, Alomari A, et al. Percutaneous sclerotherapy of lymphatic malformations with doxycycline. Lymphat Res Biol. 2008;6(3-4):209-16. [Medline].

  12. Greinwald JH, Burke DK, Sato Y, et al. Treatment of lymphangiomas in children: an update of Picibanil (OK-432) sclerotherapy. Otolaryngol Head Neck Surg. Oct 1999;121(4):381-7. [Medline].

  13. Edwards PD, Rahbar R, Ferraro NF, Burrows PE, Mulliken JB. Lymphatic malformation of the lingual base and oral floor. Plast Reconstr Surg. Jun 2005;115(7):1906-15. [Medline].

  14. Neville DD, Damm DD, Allen CM, Bouquot JE. Soft tissue tumors. In: Oral and Maxillofacial Pathology. ed. WB Saunders Co; 1995:711.

 
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Marked lingual enlargement caused by lymphatic malformation. Note the pebbly surface in areas not covered by materia alba. Also note the ecchymotic lesions protruding from the buccal mucosa in the mandibular vestibules.
Note the significant left buccal and submandibular swelling.
Profile view of a young adult with oral lymphangioma (same patient as in Media File 2).
Superficial lymphatic malformation.
Superficial lymphatic malformation.
 
 
 
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