Cervicofacial Cystic Hygroma: Experience with Intralesional Tetracycline Sclerotherapy

Background: Cystic Hygroma (CH) is a benign, painless loculated lymphatic malformation that is commoner at the cervicofacial region. About 90% of cases present before age 2 years. The ideal treatment of cervicofacial cystic hygroma (CCH) is complete surgical excision. This is often difficult to achieve without sacrificing important neurovascular structures. Intralesional Tetracycline (ILTCN) sclerotherapy explored in this study is a cheaper and safer option devoid of cosmetic challenges, morbidity and mortality of surgery.

Aims and Objectives: To document our experience and response of CCH to ILTCN as a primary modality of treatment.

Materials and Methods: Eleven patients with CCH treated by drainages and instillation of 100mg/ml of ILTCN between 2014 and 2019 are presented.  A repeated injection was performed at an interval of 3-4 weeks where necessary.

Results: Eleven patients, 7 males and 4 females aged between 1- 14 years were treated. Complete resolution was achieved with a single injection in about 80% and nearly 100% with 3 injections. One patient had a residual echogenic solid nodule (15.9mm × 14.7mm). There was no recorded case of adverse reactions other than pain at the site of injection which rarely persisted beyond 30mins.

Conclusion: Sclerotherapy with IL-TCN is a readily available, cheap, simple, safe, and effective option that can be considered as first line treatment for CCH. Surgery should be restricted to cases without satisfactory response to sclerotherapy.  With 1-2 injections of ILTCN, complete resolution in about 90% of patients is possible if as many locules of a multiloculated hygromas are drained and injected.