Treatment of a child with venolymphatic malformation of the tongue

Abstract

Relevance. Lymphatic and venolymphatic malformations account for 6-18% of benign lesions in children. In most cases, the head and neck regions are affected, with 50% of intraoral lesions occurring in the tongue. Venolymphatic malformation of the tongue leads to severe functional problems, even life-threatening, to serious esthetic defects and social maladjustment. Diagnosis and treatment of this patient population is a difficult and unsolved problem in pediatric maxillofacial surgery since there is no common algorithm for managing such patients. Purpose – optimization and improvement of the rehabilitation’s effectiveness of children with lymphatic and venolymphatic malformations of the tongue by creating a clear algorithm for the diagnosis and treatment of this patients’ group.Materials and methods. A child aged 1 year and 5 months was treated for venolymphatic malformation of the tongue, macroglossia. In addition to general clinical examination methods, the mandatory diagnostic methods were ultrasonography of pathological tissues, MRI (magnetic resonance imaging) and CT (computed tomography) of the head and neck with intravenous administration of a contrast agent, fibrolaryngoscopy. The child was operated on in two stages: the first stage was a refined resection of the tongue followed by its plastic surgery with the local tissues, the second stage was the removal of the superficial malformation of the tongue using a semiconductor laser LSPIRE-Polyus (ЛСП-«ИРЭ-Полюс»). The surgery was performed under the general anaesthesia. A histopathological examination of the specimen was performed to clarify the diagnosis.Results. The outcome of the treatment was good: functional and esthetic problems were solved, the child became socially adapted. There were no complications during the intra- and postoperative periods. The method of removing the superficial form of venolymphatic malformation of the tongue using a semiconductor laser has once again demonstrated its effectiveness (patent for invention No. 2676832).Conclusions. When examining such children, it is necessary to adhere to a specific diagnostic plan. The treatment of this patients’ group is interdisciplinary and comprehensive, with the obligatory adherence to a clear treatment algorithm, which allows achieving good functional and esthetic outcome. The advantages of laser treatment of the superficial form of venolymphatic malformation of the tongue are the reduction in the risk of recurrence due to the complete and immediate removal of pathological tissues; decrease of the invasiveness of the operation for the precise action of the laser radiation, as well as the simultaneous coagulating effect of laser radiation; improving the functional and esthetic outcome of treatment; reducing the cost of treatment for this group of patients by decreasing the period of the hospital stay.