Lymphatic malformations of the head and neck. A proposal for staging.

OBJECTIVE: To propose a staging system for patients with lymphatic malformations of the head and neck.

DESIGN: Retrospective chart review.

PATIENTS: Fifty-six patients were treated for lymphatic malformations from 1983 to 1993 at Children's Hospital and Medical Center, Seattle, Wash. The charts were reviewed for anatomic location of the lesion, preoperative and postoperative complications, number of procedures to control disease, long-term sequelae, and persistence of disease. Lesions were characterized as being unilateral or bilateral and suprahyoid and/or infrahyoid. The five patient groups were then compared with respect to the above categories.

RESULTS: Preoperative complications reviewed include preoperative infection, respiratory embarrassment necessitating airway intervention, and feeding difficulties. Postoperative complications assessed were cranial nerve injury, wound infection, and seroma formation. Long-term sequelae included malocclusion, speech delay, and cosmetic deformity. The rate of persistent disease was also assessed. A staging system was developed based on a progression of extent of disease. Stage I patients (n = 12) had unilateral infrahyoid disease and a 17% incidence of complications overall. Stage II patients (n = 17) had unilateral suprahyoid disease and a 41% incidence of complications. Stage III patients (n = 15) had unilateral suprahyoid and infrahyoid disease and a complication rate of 67%. Stage IV patients (n = 5) with bilateral suprahyoid disease had a complication rate of 80%, while stage V patients (n = 6) with bilateral suprahyoid and infrahyoid disease had a 100% incidence of complications.

CONCLUSION: Anatomic location of lymphatic malformations of the head and neck can be used to predict prognosis and outcome of surgical intervention.