Oro-facial lymphatic malformation: management with a new three steps laser protocol

Introduction and objectives. Lymphangioma, or Lymphatic Malformation (LM) according to ISSVA Classification, is a rare benign disorder with unknown etiology. LM may grow slowly over years or develop rapidly over the course of days becoming a bulky lump, infected or bleeding. Surgical excision is the gold standard treatment for adult LM with 10-15% recurrence rate and 15-30%complication rate. Other treatment modalities have also been proposed: simple aspiration with high risk for recurrence; sclerotherapy (alcohol, steroids, bleomycin or interferon) without results but only complications like fever, pain or lesion enlargement. The aim of this study is to show our three steps Laser protocol for LM management, based on its persistent vascular blood component. Methods. We select 11 patients aged between 12 and 60 years with clinical diagnosis of LM of tongue, lower lip and cheek divided in circumscriptum (<3x3cm) and major lesions (>3x3cm). LM are fluctuant and mobile suggesting a differential diagnosis from hemangioma, metastatic lesions and lymphoma. LM laser protocol includes three steps: 1. Histological and cytological examination, to evaluate the vascular blood component (10-40%), shows mature lymphocytes with red blood cells and endothelial cells. 2. Diode Laser Photocoagulation (DLP) in pulsed mode (on 190-250ms / off 250-450ms) at 14-20W and 800nm, to reduce the lesion. 3. Diode Laser surgical excision with histological intraoperative margins control on frozen sections. Results and conclusions. Histological analysis, highlighting the vascular blood component in all LM, validates photocoagulation and surgical combined approach with Diode Laser. Even if it has inconstant results (lesions decreasing rate is 10% to 40% proportionally to vascular blood component), DLP simplifies the last and the most important step. Use of Diode Laser also in surgical excision resets bleeding, infection and lymphorrhea to zero, accelerates healing time and improves aesthetic results.