Lymphangioma

case presentation

1. LYMPHANGIOMA Lymphangiomas are benign tumours of lymphatic vessels showing marked predilection for head and neck region.

2. They are extremely rare in the oral cavity . The common site of occurrence for lymphangioma in the oral cavity is the anterior dorsum and lateral border of tongue .

3. Other parts of oral cavity such as the palate, cheeks, floor of the mouth, gingiva and lips.

4. Classification of lymphangioma , Watson and McCarthy Simple lymphangioma Cavernous lymphangioma Cellular lymphangioma Diffuse systemic lymphangioma Cystic lymphangioma

5. LM divided into two types 1. Macrocystic 2.Microcystic Superficial seated Deep seated

6. Serres et al. A staging system based on the location and extent of the lesions: stage I is unilateral infrahyoid , stage II is unilateral suprahyoid , stage III is unilateral infrahyoid and suprahyoid , stage IV is bilateral infrahyoid , stage V is bilateral infrahyoid and suprahyoid . Staging of LM

7. Management of lymphangioma Various methods have been reported for the treatment of lymphangiomas . Procedures such as 1)Surgical excision 2)Radiation therapy, 3) Cryotherapy ,

8. 4) Electrocautery , 5) Sclerotherapy , 6)Steroid administration, 7) Embolisation , 8)Ligation, 9) Laser surgery

9. Conservative treatments including radiotherapy, electrocoagulation , cryotherapy , ligation, embolization , sclerotherapy and laser therapy have been recommended as a primary or adjunctive treatment for lymphangioma .

10. LASER THERAPY- Carbon dioxide (CO2) laser is the most commonly used laser for treatment of lymphangioma due to its affinity with water and high absorption by the oral mucosa.

11. The interaction of the laser light with the tissue occurs by the transformation of the light into heat in the presence of fluids, mainly water. Besides CO2 laser, Nd:YAG laser, pulsed dye laser and diode laser can also be used.

12. Advantage of laser in lymphangioma Coagulation of small blood vessels and lymphatic vessels, making the surgical field drier. Reducing the risk of metastasis. Decreasing postoperative pain and discomfort due to the formation of thermal neuromas at the nerve endings.

13. Immediate sterilization of wound surface due to the high temperature generated during the irradiation. Minimal or no wound contraction and scarring due to the presence of small amount of myofibroblasts . No need of sutures or wound dressings,

14. Disadvantages of laser in lymphangioma Slightly delay on wound healing that occurs due to the thermal damage around the irradiation site. High cost of the equipment, Need of surgeon training on laser use

15. Sclerotherapy Intralesional injections of sclerosing agents such as 25% dextrose, hypertonic saline, bleomycin , aethoxysklerol , or OK-432 ( picibanil ) are recommended for treatment of lymphangioma .

16. Eight milligrams of Pingyangmycin powder is dissolved in 5 mL normal saline with addition of 2 mL 2% lidocaine hydrochloride and 1 mL dexamethasone . The dosage per injection is 1 mL /cm2 of the lesion as determined by clinical measurement, The maximal dose for one injection is 8 mg, and the total dose should not exceed 40 mg in an adult patient.

17. Disadvantage Very few patients develop low grade fever, loss of appetite and skin rash.

18. Cryosurgery Cryotherapy , also known as cryosurgery, is a commonly used for the treatment of lymphangioma .. The mechanism of destruction in cryotherapy is : Intracellular ice formation that leads to cell rupture.

19. An increase in solute concentration within the damaged tissue. Inflammation in the damaged tissue. Liquid nitrogen apparatus (CRY-AC; Brymill , Ellington , CT, USA) was used to perform the cryotherapy .

20. Lymphangiomas are thought to be very suitable for treatment by cryosurgery because of their high fluid content and poor blood supply.

21. Surgical management Complete surgical excision remains the most accepted treatment option for lymphangioma . Most adult lymphangiomas are encapsulated or partially circumscribed and thus surgical removal is facilitated

22. Successful treatment requires the inclusion of a surrounding border of normal tissue, provided that vital structures are not damaged.

23. Complication of surgery Damage to surrounding vital structures, nerves and blood vessels, Prolonged lymphatic drainage from the wound, wound infections, and unacceptable scar formation The chances of recurrence following the surgery may be high, (10% to 38%)

24. THANK YOU