Hakimi Turyalai
Chief Division of Pediatric Surgery, Kabul University of Medical Science, Maiwand Teaching Hospital, Kabul, Afghanistan.
Ann Med Surg (Lond). 2023 Apr 5;85(5):1923-1927. doi: 10.1097/MS9.0000000000000452. eCollection 2023 May.
Lymphangiomas are benign congenital defects affecting the lymphatic system. These lesions commonly involve the head and neck, predominantly the posterior cervical triangle. Lymphangiomas cause obstructive symptoms in the upper airway and pose an esthetic concern to the patient. Clinically, these lesions are seen as cervical swelling, and a definite diagnosis is made by ultrasonography, computerized tomography scanning, and histopathologic analysis. Herein, the author present an unusual case of an 18-month-old child presenting with a huge cervical swelling on the right side with extension to the carotid triangle (encompassing neck great vessels) as well as unilateral neck and fascial disfigurement. The patient was treated surgically with the complete excision of the mass and followed up with an excellent esthetic result.
An 18-month-old child was brought to our teaching hospital's pediatric surgery department with a huge cervical mass on the right side since birth. Following the completion of work-up with the laboratory and imaging (computerized tomography scan) diagnostic modalities, the patient was prepared for definite treatment. Our team approached the mass through a right neck hockey stick incision, and with the preservation of the neurovascular bundle, the mass was completely excised. The patient was followed up for 12 months on two occasions, with excellent esthetic results and no relapse.
Lymphangiomas confined to the posterior cervical triangle are a common problem in children. Lesions extending to the anterior of the neck, especially those involving the neck neurovascular bundle, are uncommon entities. The decision to proceed with sclerotherapy or surgical excision should be justified, provided that, during the surgical procedure, the neurovascular bundle is preserved and none of the vital organs (neurovascular components) are compensated with the goal of a complete mass excision.
淋巴管瘤是影响淋巴系统的良性先天性缺陷。这些病变通常累及头颈部，主要是颈后三角区。淋巴管瘤可导致上呼吸道阻塞症状，并给患者带来美观问题。临床上，这些病变表现为颈部肿胀，通过超声、计算机断层扫描和组织病理学分析可做出明确诊断。在此，作者介绍了一例不寻常的病例，一名18个月大的儿童右侧颈部巨大肿胀，延伸至颈动脉三角区（包括颈部大血管），伴有单侧颈部和筋膜畸形。该患者接受了手术治疗，完整切除了肿块，术后随访结果美观。
一名18个月大的儿童自出生以来右侧颈部有巨大肿块，被带到我们教学医院的小儿外科。在完成实验室检查和影像学（计算机断层扫描）诊断后，为患者准备进行明确治疗。我们的团队通过右侧颈部曲棍球棒切口接近肿块，在保留神经血管束的情况下，完整切除了肿块。患者分两次接受了12个月的随访，结果美观，无复发。
局限于颈后三角区的淋巴管瘤在儿童中是常见问题。延伸至颈部前方的病变，尤其是涉及颈部神经血管束的病变，是罕见的情况。在进行硬化治疗或手术切除的决策时应合理，前提是在手术过程中保留神经血管束，且不以切除完整肿块为目标而牺牲任何重要器官（神经血管成分）。
