Abstract
Objective: 1) Systematically review the literature pertaining to head and neck (H&N) lymphatic malformation (LM) treatment, and use individual level data presented in qualifying case-series to compare efficacy, complications, and functional impact among surgery and sclerotherapy. 2) Evaluate whether treatment modalities differed by LM stage.
Method: Using Ovid and search terms lymphangioma, cystic hygroma, and lymphatic malformation, we performed a literature search yielding 6,292 references. Excluding references that did not: involve H&N LM treatment, include at least 5 patients, follow patients for one year, define treatment, and state complications, yielded 29 articles with individual level data.
Results: We pooled individual case data from case series, indentifying 157 patients treated with surgery and 132 patients treated with sclerotherapy. Advanced stage LM were more likely to be treated with surgery (24 (15.8%)) than sclerotherapy (34 (28.1%)). Advanced stage LM had increased levels of persistence in both surgically treated and sclerosed patients. One sclerotherapy treatment was used in 45 (34%), 2 in 35 (26.5%), and three or more in the remainder. The report of complications and functional impact was inconsistent among papers.
Conclusion: Currently no standardized reporting system of LM case series exists, making it difficult to compare treatments. Our data suggest that sclerotherapy may be more efficacious, with fewer side effects than surgery; however, our evaluation did not take into account the potentially confounding effects of LM stage, treatment indications, and complications.
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