Head and Neck Lymphatic Malformation Management Algorithm: An Experience from a Tertiary Centre in Tanzania

Abstract

Background: Lymphatic malformations are localized areas of malformed lymphatic system that can either be congenital or acquired which commonly occur in the head and neck region. Several treatment options for lymphatic malformations have been proposed, despite this, there is no consensus as to optimal management. Objective: To determine the pattern and management of head and neck lymphatic malformations in a tertiary health facility in Tanzania. Material and Methods: This was a one-year cross sectional study that involved patients with head and neck lymphatic malformations treated in Muhimbili National Hospital. A structured questionnaire was used to collect information including age and sex of the patient, chief complaint and, duration, size and site of the lesion. The treatment modalities were surgery and/or intralesional bleomycin injection (IL-Bleo) using a locally developed algorithm. A standard dose of bleomycin was 0.3 to 0.6 mg/kg per injection not exceeding 15 units per cycle with a maximum of 6 cycles. Results: a total of 33 patients were included in the study. Males were 21 (63.6%) and the male to female ratio was 1.8:1. The age of patients ranged from 5 months to 28 years with a median age of 6 years. In 29 (87.9%) patients, the lesions were evident during birth. The median area covered by the lesion in 2 patients was 12.00 cm . Nine (27.3%) patients were managed by surgery alone, while majority (24, 72.7%) were given intralesional bleomycin (IL Bleo), of whom majority (20, 83.3%) required surgical intervention subsequently. The overall outcome of management of patients was considered successful in 87% of patients. Conclusion: Head and neck lymphatic malformations are more common in males. Most of the lymphangiomas are of congenital type. Combining IL-Bleo and surgery an effective way of managing head and neck lymphatic malformations.