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Diagnosis, Classification, and Treatment

Susanne Wiegand, MD; Behfar Eivazi, MD; Annette P. Zimmermann, MD; Andreas Neff, MD, PhD; Peter J. Barth, MD, PhD; Andreas M. Sesterhenn, MD, PhD; Robert Mandic, MD, PhD; Jochen A. Werner, MD, PhD

Arch Otolaryngol Head Neck Surg. 2009;135(10):976-983.

Objective  To describe a classification of microcystic lymphatic malformations of the tongue and to investigate different treatment methods.

Design  Retrospective review of patients treated for microcystic lymphatic malformations of the tongue. Lymphatic malformations were classified into the following 4 groups according to their extent: isolated superficial microcystic lymphatic malformations of the tongue (stage I); isolated lymphatic malformations of the tongue with muscle involvement (stage II; stage IIA, involving a part of the tongue; stage IIB, involving the entire tongue); microcystic lymphatic malformations of the tongue and the floor of mouth (stage III); and extensive microcystic lymphatic malformations involving the tongue, floor of mouth, and further cervical structures (stage IV).

Patients  Twenty patients with microcystic lymphatic malformation of the tongue.

Main Outcome Measures  Medical records were reviewed for demographic data and extent and treatment of the lymphatic malformations.

Results  Three patients had stage I disease; 5 patients, stage II; 3 patients, stage III; and 9 patients, stage IV. In 6 patients, the lymphatic malformations could be completely removed by carbon dioxide laser surgery; the remaining 13 patients had persistent disease.

Conclusions  The initial stage seems to predict outcome. Carbon dioxide laser therapy provides good results primarily in stages I and IIA lymphatic malformations. In advanced lymphatic malformations (stages IIB, III, and IV), an interdisciplinary approach is necessary, because complete surgical excision is often impossible owing to the diffuse growth behavior, and therefore recurrence and persistence are common.

Author Affiliations: Departments of Otorhinolaryngology–Head and Neck Surgery (Drs Wiegand, Eivazi, Zimmermann, Sesterhenn, Mandic, and Werner) and Oral and Maxillofacial Surgery (Dr Neff) and Institute of Pathology (Dr Barth), Philipps-Universität Marburg, Marburg, Germany.

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