Extensive Maxillofacial Lymphangioma With Suppuration in the Late Postnatal Period of a Child

Abstract

Lymphangiomas have a dysontogenetic origin, that is, they occur during the development of the fetus and are treated as an abnormal development of the endothelium of proliferating lymphatic vessels and manifest clinically, most often immediately after the birth of a child or in infancy.
 According to data published earlier by the staff of our department, among benign tumors of soft tissues of maxillofacial area, dermoid cysts (32.6%) take first place. The second place is given to hemangiomas (26.0%); lymphangiosis of such localization are quite rare, accounting for only 3% of the total number of tumors of soft tissues of the face and neck, which causes certain features of tactical approaches to choice and scope of diagnostic measures. In general, lymphangioma, a malformation of the lymphatic system, accounts for 9% of all soft tissue germline tumors and is diagnosed immediately after birth in 65-85% of children, with their superficial location.
 When they are located in the maxillofacial region, aesthetic deficiencies or functional impairments can be quite pronounced. The features of their topographic-anatomical location in deep fiber spaces and in the area of the floor of the oral cavity cause considerable difficulties in the conduct of diagnostics, the choice of tactical operating techniques and methods of treatment, because the postoperative period is accompanied by a high probability of complications. The presented content of the medical history indicates that the diagnosis of deep-seated and bulky lymphangiomas in young children is rather difficult. Especially, when it comes to festering and combined with acute infectious somatic diseases, it can provoke the occurrence of the inflammatory process directly in the lymphangioma.
 Attention is drawn to the fact that the frequency of diagnostic errors at the prehospital stage is 75%. Basically, the children were sent to hospital with an incorrect diagnosis, although they were under the supervision of district pediatricians for a long time and repeatedly looked around at a pediatric surgeon.
 The purpose of our study was to study the peculiarities of clinical manifestations and the diagnosis of volumetric, deep-seated lymphangiomis of the maxillofacial focal infiltration in a child of infancy.
 Routine diagnostic methods, such as needle biopsy and modern computed tomography, make it possible to unify the diagnostic process to a great extent and decide on the optimal option for operative access and the volume of surgical intervention. There are also certain difficulties in the choice of pharmacological drugs and their dosage when it comes to the combination of a diffuse purulent process with acute manifestations of the pathology of infectious origin. This category of children is subject to dynamic observation to exclude the possibility of recurrence of lymphangioma in conditions of its incomplete necrotization with timely involvement of measures.