Cryotherapy for the management of a lip lymphangioma – a case report and literature review

Abstract

Lymphangiomas or lymphatic malformations have a diverse presentation within the head and neck. This case report explores the use of cryotherapy as an alternative treatment strategy for such oral lesions with a review of literature. A 12 year‐old female presented with an uncommon lower lip lymphangioma. Due to aesthetic concerns she was treated with one session of cryotherapy as a relatively potential novel treatment. Clinically the patient had some reduction in size of the lesion with no significant post‐operative complications. The use of cryotherapy could be considered as a treatment option in small oral cavity lymphangiomas within the aesthetic zone but may not always provide complete resolution or success.

Lymphangioma of the Lower Lip—A Diagnostic Dilemma: Report of a Rare Case with a Brief Literature Review

“…There exists a diverse pattern in defining lymphangiomas; however, the nonneoplastic proliferation of lymphatic channels delineating a lymphatic hamartoma represents the classical description of lymphangiomas [ 27 ].…”

“…The lymphatic channels persistently accumulate lymph; however, they fail to join with the larger vessels, causing lymphatic obstruction, thus imparting a cystic appearance [ 7 ]. They are rare entities with an incidence of about 1 : 6,000 to 1 : 16,000 live births and are attributed to about 6% of benign, 11% of maxillofacial tumors, and 9% of soft tissue tumors in the pediatric age group [ 3 , 27 , 28 ].…”

“…They frequently manifest as a long-standing, asymptomatic, progressively expanding soft tissue mass that has been reasonably inactive, with intermittent episodes of exacerbation and remission, eventually remaining as a residual mass [ 3 , 12 , 31 ]. Superficial lymphangiomas typically manifest as pebbly, vesicle-like lesions, with the characteristic “frog-egg” or “tapioca pudding” presentation, although occasionally, the vesicles may appear purplish/bluish-red owing to the secondary hemorrhage into the lymphatic system [ 3 , 10 , 13 , 14 , 27 ]. However, a soft, diffused nodular submucosal mass with a similar texture and color as the contiguous mucosa depicts the classical description of deep-seated lymphangiomas [ 3 , 12 – 14 ].…”

“…Several detrimental effects such as breathing and speech difficulty, pain, tongue protrusion, or jaw anomalies may be seen with deep lesions owing to the impingement on the contiguous anatomical structures [ 3 , 13 , 27 ].…”

“…The first hypotheses propose that congenital lymphangiomas result from sequestration of primordial lymphatics; however, they fail to connect to the main lymphatic vessels or veins [ 34 ]. The second hypothesis states that the failure of the lymphatic vessels to drain into the veins causes lymph accumulation and leads to the formation of large cyst-like dilated lymphatics [ 27 ]. According to the third hypothesis, lymphangiomas may develop through aberrant budding of the lymphatic vessels, thus establishing new anomalous divisions.…”