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Int J Pediatr Otorhinolaryngol. 2009 Aug;73(8):1114-8. doi: 10.1016/j.ijporl.2009.04.016. Epub 2009 Jun 9.

Management of lymphatic malformations and macroglossia: results of a national treatment survey.

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  • 1Department of Otolaryngology-Head & Neck Surgery, United States Naval Hospital Okinawa, Japan. david.bloom@med.navy.mil

Abstract

OBJECTIVE:

To determine current trends among American Society of Pediatric Otolaryngology members on the treatment of various stages of lymphatic malformation (LM) with an emphasis on tongue management.

METHODS:

We queried the members on practice demographics, number of LMs and LM-Mac treated, preferred treatment of different stages of LM and Lm-Mac, indications for LM-Mac tongue treatment, preferred method of surgical tongue reduction, and medical management of acutely enlarging LMs and LM-Mac.

RESULTS:

39/329 (12%) American Society of Pediatric Otolaryngology members responded to the survey. Airway obstruction or obstructive sleep apnea (27/39, 69%) followed by recurrent tongue trauma with bleeding, pain or mucosal changes (11/39, 28%) were the most common indications for tongue management. 16/37 (43%) of respondents preferred staged tongue reduction followed by neck dissection (cervical approach to the LM), 8/37 (22%) preferred staged neck dissection followed by tongue reduction, and 13/37 (35%) preferred simultaneous treatment of the tongue and neck. The preferred methods of tongue reduction were superficial laser ablation (17/38, 45%) and surgical excision (14/39, 36%). The preferred methods of surgical tongue reduction were anterior wedge (18/38, 47%) and midline keyhole reduction (13/38, 34%). For rapidly enlarging lymphatic malformations involving the tongue, the majority of respondents indicated that they would admit and observe (34/38, 89%), give steroids (34/37, 92%) and administer antibiotics (35/38, 92%).

CONCLUSIONS:

While providing insight into treatment patterns, this survey also helps to elucidate the need for multicenter trials for treatment of LM to develop a standard of care that can be recommended based on evidence based medicine rather.

PMID:
19515431
[PubMed - indexed for MEDLINE]
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