Objective:To present experience and evaluate the safety and efficacy of surgery combined with
bleomycin irrigation for the management of head and neck lymphatic malformations in children. Methods:The medical records of all patients with cervical-facial lymphatic malformations who presented to Shanghai Children's Hospital from August 2014 to December 2020 were reviewed. 97 children were divided into surgery group(81 cases) and
sclerotherapy group(16 cases). Conventional contrast-enhanced magnetic resonance imaging(MRI) and B-ultrasound examinations were performed both preoperatively and postoperatively. The surgical group received
lymphangioma resection combined with
bleomycin irrigation. The
sclerotherapy group was treated with B-ultrasound-guided percutaneous
lymphangioma aspiration and
bleomycin sclerotherapy. SPSS 21.0 software was used to evaluate the clinical cure rate and postoperative complications of lesions in both groups by chi-square test. Kaplan-Meier method was used to calculate the disease-free survival rate and draw survival curve. Results:In the surgery group of 81 children, 64 cases were cured and 17 cases were effective while in the
sclerosis group, 8 cases were cured and 8 cases were effective. Cox proportional risk model found that children in the surgery group had a higher cure rate and a lower risk of 5-year recurrence than those in the
sclerotherapy group, with statistically significant differences(χ²=5.814, P<0.05). The risk of recurrence in the surgery group was 35.4% of that in the
sclerotherapy group(HR=0.354, P<0.05). In regards to postoperative complications, the surgical group had no higher rate of temporal
facial paralysis and other nerve
injuries compared to the
sclerotherapy group(χ²=1.041, P=0.308). Conclusion:Surgery combined with
bleomycin irrigation in the complex cervical-facial lymphatic malformations was confirmed to be effectively and safely. The principle of the surgery was to protect the structure and function of normal tissue while excising the lesions as much as possible. When the lesions involved the posterior two-thirds of the tongue, the floor of the mouth, parapharynx, retropharynx, or hypopharynx spaces.
Radiofrequency ablation was used in the surgical excision, which made the surgery more minimally invasive, accurate and personalized.