Excision of Macrocystic Lymphatic Malformation

Video Type: CVideo
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Author: Ravi Sun
Published:
Specialties: Head and Neck Surgery, Otolaryngology, Pediatric Otolaryngology
Schools: Arkansas Children's Hospital, University of Arkansas for Medical Sciences
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Basic Info

Introduction

Lymphatic malformations (LM) are composed of dilated, abnormal lymphatic vessels classified as macrocystic (single or multiple cysts >2 cm3), microcystic (<2 cm3), or mixed. This patient is a 5-month-old with a right neck mass consistent with macrocystic lymphatic malformation on MRI. This low-flow vascular malformation required surgical intervention.

Methods

The site was marked in a natural skin crease. Subplatysmal flaps were raised and malformation was immediately encountered. Blunt soft tissue dissection was performed immediately adjacent to the mass to reflect tissue off the fluid-filled lesion. Neurovascular structures were preserved in this process. Mass was removed in total and Penrose drain and neck dressing were placed.

Results

A complete resection was performed. LM was confirmed on pathology. Patient is doing well with no deficits noted. The drain was removed after 1 week. One-month follow-up showed no recurrence.

Conclusion

Macrocystic lymphatic malformations are amenable to surgical resection at low risk and without recurrence.

By: Ravi W Sun, BE

Surgeons:

Luke T Small, MD

Gresham Richter, MD

Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Arkansas Children's Hospital, Little Rock, AR, USA

Recruited by: Gresham T Richter, MD

Advanced

Procedure

1. A 6 centimeter incision was made and carried through the platysma.
2. Subplatysmal flaps were elevated superiorly and inferiorly.
3. Fascial bands overlying the mass were divided.
4. Overlying fascial tissue was gently dissected circumferentially around the mass.
5. Great care was taken to not violate the surrounding structures.
6. Bipolar cautery was used to divide the facial attachments of the deep layer of the mass.
7. The incision was closed in a layered fashion.
8. A 1/4 inch penrose drain was added and removed a few days later.

Indications

Enlarging neck mass
Lymphatic malformation

Contraindications

None apparent. More complicated if prior treatment or sclerotherapy.

Instrumentation

Setup

Arrange field and instrumentation for standard neck dissection.

Preoperative Workup

MRI imaging and follow up to note changes in mass.

Anatomy and Landmarks

Anatomy described in the video. We note standard landmarks defined in any neck dissection.

Advantages/Disadvantages

Advantage
Surgical excision often is the definitive treatment, with low risk of recurrence that can be treated with touch up sclerotherapy if needed.

Disadvantage
In comparison to sclerotherapy, potential for scarring increased as well as marginal risk of damage to surrounding structures.

Complications/Risks

Low risks: chronic drainage, potential scar, functional deficits, recurrence, postoperative seroma, infection, bleeding, nerve injury, great vessel injury.

Disclosure of Conflicts

None

Acknowledgements

Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Arkansas Children's Hospital, Little Rock, AR, USA

References

Richter GT, Suen JY. Head and Neck Vascular Anomalies. (Plural Publishing Inc., San Diego, CA, USA, 2015), pp. 229-314.

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