Zur Lokalisation lymphatischer Malformationen an Hals und Mundboden

Lymphatic malformations are rare, benign, congenital malformations of the lymphatic vessels, which can be located anywhere on the body but mostly occur in the head and neck region. The aim of the present study was to analyze the distribution and localization of lymphatic malformations of the head and neck, in order to draw conclusions about the prognosis, an adequate therapy and if applicable the aetiology. The data from 761 patients with vascular anomalies, who were treated at the University Clinic Giessen and Marburg, site Marburg, Department of Otorhinolaryngology, between 1997 and 2010, were analyzed. 48 patients (24 male, 24 female) fulfilled the inclusion criteria “lymphatic malformation” and “localization in the neck or floor of mouth”. The lymphatic malformations were located in 44% left-sided, in 21% right-sided and in 35% on both sides. 27% of the lesions were macrocystic, 45% micorcystic and 27% mixed. 10,4% of the patients belonged to stage I according to de Serres (unilateral infrahyoidal), 31% to stage II (unilateral suprahyoidal), 23% to stage III (unilateral supra- and infrahyoidal), 10,4% to stage IV (bilateral suprahyoidal) and 25% to stage V (bilateral supra- and infrahyoidal). 16,8% of the patients scored a Cologne-Disease-Score (CDS) of 1-4 points, 18,9% 5-7 points and 64,6% 8-10 points. The results show that the Cologne-Disease-Score correlates with the stage according to de Serres (low stage - high CDS) and the microscopic type (macrocystic lymphatic malformation - high CDS). Further the evaluated data show that macrocystic malformations are localized almost exclusively cervical while microcystic malformations infiltrate predominantly the floor of the mouth. Despite the balanced gender ratio differences appeared in the distribution of the stages according to de Serres. Lymphatic malformations in stage I occurred only in females, whereas in stage V a clear preponderance of males occurred. There are different approaches for the treatment of lymphatic malformations. In our data surgical treatment was the most frequently used method that showed good curative results especially for macrocystic lesions in low stages. For just these macrocystic lesions in low stages recent studies also show very good results with sclerotherapy. For microcystic lesions of the tongue and floor of mouth the laser therapy has proven to be a good therapeutic option. Especially in patients with larger lymphatic malformations, however, a combined therapy is most likely to be effective. Overall the evaluated patient population showed for microcystic and mixed malformations a considerable higher rate in residual malformations after therapy than for macrocystic malformations.