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Sclerotherapy for lymphatic malformations of the head and neck in the pediatric population
  1. Joanna H Tu1,2,
  2. Huy M Do3,
  3. Viraat Patel4,
  4. Kristen W Yeom5,
  5. Joyce M C Teng6
  1. 1College of Physicians and Surgeons, Columbia University, New York, New York, USA
  2. 2Department of Dermatology, Stanford University, Palo Alto, California, USA
  3. 3Departments of Radiology and Neurosurgery, Stanford University, Palo Alto, California, USA
  4. 4Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
  5. 5Department of Radiology, Stanford University, Palo Alto, California, USA
  6. 6Department of Dermatology, Stanford University, Palo Alto, California, USA
  1. Correspondence to Dr Joyce M C Teng, 700 Welch Rd 301G, Palo Alto, CA 94304, USA; jteng3{at}


Background Sclerotherapy is one of the most commonly used minimally invasive interventions in the treatment of macrocystic lymphatic malformations (LMs). Several different sclerosing agents and injection protocols have been reported in the literature, each with varying degrees of success. The safety and efficacy of the treatments have not been evaluated comparatively in the pediatric population.

Methods Chart review of pediatric patients with macrocystic/mixed head and neck LMs who underwent sclerotherapy using OK-432, doxycycline, or ethanolamine oleate at Lucile Packard Children's Hospital at Stanford during 2000–2014. Clinical evaluation and radiographic imaging were reviewed to assess lesion characteristics and response to sclerotherapy following each treatment session. The post-intervention clinical response was categorized as excellent, good, fair, or poor.

Results Among the 41 pediatric cases reviewed, 10 patients were treated with OK-432, 19 patients received doxycycline, and 12 patients received ethanolamine. In univariate analysis, different sclerosants had similar effectiveness after the first injection and final clinical outcome (p=0.5317). In multivariate analysis controlling for disease severity stage as well as disease characteristics (macrocystic vs mixed subtypes), different sclerosants also had similar effectiveness after the first injection (p=0.1192). Radiologic analysis indicated an 84.5% average volume reduction, with similar effectiveness between the different sclerosants (p=0.9910).

Conclusions In this series of LM cases treated at Stanford, we found that doxycycline, OK-432, and ethanolamine oleate sclerotherapy appear to have a similar safety and efficacy profile in the treatment of macrocystic and mixed LMs of the head and neck in the pediatric population.

  • Intervention
  • Malformation
  • Neck
  • Pediatrics
  • Vascular Malformation

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  • Contributors Each author made a material contribution to the article, its revision and the final approval of the article for submission.

  • Competing interests None declared.

  • Ethics approval Ethics approval was obtained from Stanford Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.