Introduction: Macrocystic lymphatic malformations (MLM) are amenable to sclerotherapy (SCT) and surgical resection but unilateral suprahyoid disease (DeSerres II) has a high surgical complication rate of 41%. Treatment may be necessary for MLM causing disfigurement, recurrent swelling, pain, and infections. While SCT traditionally helps in MLM, the mucoid effusion from LM infiltration into the adjacent submandibular gland (SMG) makes SCT less effective. The use of N-Butyl cyanoacrylate (n-BCA) injections within venous malformations as glue aiding surgical resection has been published. This series of patients with SMG LM who failed or were not deemed a good candidate for SCT, were treated with immediate preoperative n-BCA embolization in the resection of refractory SMG MLM.
Methods: A retrospective chart review of all patients with SMG LM who underwent immediate preoperative n-BCA embolization and resection from January 2019 till September 2021. Same day excision of LM utilizing n-BCA glue embolization was performed by interventional radiology and ENT. Data collected included patient demographics, comorbidities, LM location, previous treatments, intraoperative findings, LM recurrence, complications, and anesthesia time.
Results: 5 patients consisting of 2 males with a mean age of 14.40± 1.95 years were included. The lesion was most commonly located in the right (n=3) SMG area. Prior interventions included SCT (n=3), SCT and incision and drainage (n=1) and none, which was deemed a poor candidate for SCT(n=1). On average, 112± 21.24 min of anesthesia time was added for glue embolization. Mean OR time was 177.4± 75.61min. Complete gross resection of the LM was achieved in all cases. There was short term marginal weakness in 1 patient but no long term sequelae (Follow up ranged from 6 months to 2 years). US performed on 2 patients on follow up showed no recurrence. No clinical recurrence was detected at a mean follow up of 4.45months.
Conclusion: Immediate preoperative n-BCA glue and subsequent surgical excision is a viable method for treating complex SMG LM. Preoperative n-BCA glue may be a safe modality that facilitates dissection and treatment of SMG MLM which is known to be more recalcitrant with sclerotherapy.