What are the indications for excision of a lymphatic vascular malformations?

 

All lymphatic vascular malformations are candidates for surgical removal as soon as they are identified unless removal would put normal structures (nerves, blood vessels, etc.) at risk, or if surgery would likely cause a significant cosmetic deformity (abnormality of appearance). 

In some very small infants, who do not have symptoms associated with a lymphatic vascular malformations, the excision of the cyst should be performed promptly, before the cyst becomes larger and involves other structures. Removal is also performed as soon as possible if a cyst blocks the airway and causes BREATHING DIFFICULTIES; occasionally a TRACHEOSTOMY (breathing tube placed into the neck below the obstruction) will need to be placed until the cyst is removed. 

 

What is involved with the excision of a lymphatic vascular malformations?

 

Prior to surgical removal, the extent of the cyst is evaluated by imaging studies such as MRI or CT scans, Excision is performd under general anesthesia (patient is fully asleep). A surgical incision is made in the area of the cyst. As the size of these cysts can be very large and can extend in to multiple different head, neck and chest areas, the location of the incision varies among patients. These cysts also do not have a very defined capsule and often wrap around vital structures in the neck (blood vessels, nerves, muscles). For this reason, the surgeon will need to carefully perform a neck "dissection", removing the growth from normal neck structures before the rest of the cyst can be removed. 

If part of a cyst is too close to a vital structure, part of the cyst may not be able to be removed. The length of this potentially complex surgery varies with the extent of the cyst.

 

If part of the cyst is unable to be removed, regular follow up is necessary to check for recurrence. This may be done simply by physical exams (looking to see if a lump reappears). However, cysts removed in areas of the body that can't be seen will require periodic MRI studies.

If surgery is not an option due to extent of the lesion, sclerotherapy may be considered. This would involve injecting chemicals into the cyst to create shrinkage and scarring. In patients with large cysts, this is can be very successful.

 

What are the complications of this procedure?

 

Infections of the surgical site and bleeding are potential complications.

Recurrence of the lesion is always a concern, even if it appears that the entire cyst has been removed successfully. Recurrence is assured if any of the cyst remains after surgery.

 

Also of concern is the fact that the lesion is often is in close contact with important structures in the neck and complications can arise from damage to these structures. Some of these structures include the FACIAL NERVE, RECURRENT LARYNGEAL NERVE, and carotid artery (supplies blood to the head). It is important to remember that not all patients will have cysts close to these vital structures, decreasing this concern for those patients.

Damage to these structures is also minimized during surgery by your surgeon, who has extensive training and expertise in locating these structures. Your surgeon will discuss with you at length the specific concerns associated with removing your child's cyst prior to surgery.