eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Oral Lymphangiomas: Follow-up

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
Coauthor(s): Joseph Helman, DMD, Clinical Professor and Chair, Department of Oral and Maxillofacial Surgery, University of Michigan
Contributor Information and Disclosures

Updated: Jun 16, 2009

Follow-up

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.

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.¹⁰
  • 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%.

Miscellaneous

Medicolegal Pitfalls

• In sclerotherapy, adhering to a single treatment modality and failing to consider potential therapeutic modalities available is a pitfall.

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.

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