LYMPHANGIOMA

Lymphangiomas are benign tumours of lymphatic

vessels showing marked predilection for head and

neck region.

•They are extremely rare in the oral cavity.

• The common site of occurrence for lymphangiomain the oral cavity is the anterior dorsum and lateral border of tongue.

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

Classification of lymphangioma,

Watson and McCarthy

1) Simple lymphangioma

2) Cavernous lymphangioma

3) Cellular lymphangioma

4) Diffuse systemic lymphangioma

1) Cystic lymphangioma

LM divided into two types

1. Macrocystic

2.Microcystic Superficial seated

Deep seated

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.

Management of lymphangioma

Various methods have been reported for the

treatment of lymphangiomas.

Procedures such as

1)Surgical excision

2)Radiation therapy,

3)Cryotherapy,

4)Electrocautery,

5)Sclerotherapy,

6)Steroid administration,

7)Embolisation,

8)Ligation,

9) Laser surgery

Conservative treatments including radiotherapy,

electrocoagulation, cryotherapy, ligation,

embolization, sclerotherapy and laser therapy

have been recommended as a primary or adjunctive

treatment for lymphangioma.

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.

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.

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.

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,

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

Sclerotherapy

Intralesional injections of sclerosing agents such

as 25% dextrose, hypertonic saline, bleomycin,

aethoxysklerol, or OK-432 (picibanil) are

recommended for treatment of lymphangioma.

Eight milligrams of Pingyangmycin powder is dissolved in 5 mL normal saline with addition of 2 mL 2% lidocaine hydrochloride and 1 mLdexamethasone.

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.

Disadvantage

Very few patients develop low grade fever,

loss of appetite and skin rash.

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.

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.

Lymphangiomas are thought to be very suitable for

treatment by cryosurgery because of their high

fluid content and poor blood supply.

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

Successful treatment requires the inclusion of a

surrounding border of normal tissue, provided that

vital structures are not damaged.

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%)

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