Doxycycline sclerotherapy as a primary treatment of head and neck giant cystic hygroma: A case report study

TL;DR

A 11-month-old child with a large neck cyst was successfully treated with a single doxycycline injection, showing complete resolution without recurrence.

Contribution

Doxycycline sclerotherapy as a one-time treatment for giant cystic hygroma is presented as a safe and effective alternative to surgery.

Findings

A single doxycycline sclerotherapy session led to complete resolution of the cystic hygroma in 12 weeks.

The treatment caused no recurrence during a 6-month follow-up period.

The results were comparable to studies using multiple injections over time.

Abstract

Cystic hygroma is a benign lymphatic malformation, developing around 6th gestational week. The big challenge is in the way they are managed due to their extension within the vital elements. Treatment options include watchful waiting, surgery, sclerotherapy and combination between them in some cases.

We present a rare case of giant cystic hygroma of a 11-month-old male was referred to the Department of Otolaryngology for an asymptomatic, aesthetically unappealing swelling in the neck since 9 months. A well-defined large cystic mass measures about (4 × 7 × 9 cm) was seen in the CT scan, originating at the left lateral neck. It extends from the left submandibular space inferiorly posterior to the sternocleidomastoid muscle, and retrosternally to the aortic arch level. From the Posterior aspect, the mass reaches the prevertebral space. No lymph adenopathy was noted. No bony erosions. Findings are suggestive of Cystic Higroma (CH).The primary treatment was sclerotherapy using doxycycline for one time. The procedure was performed at an operating theatre under general anesthesia because injection of the sclerosant factor is painful. The child was monitored for 3 months after the procedure (with an interval of one month between each observation). There was a noticeable improvement after 4 weeks and the complete resolution of the cystic hygroma was observed 12 weeks after the initial procedure. During the monitoring period of 6 months, the lesion did not show any recurrence.

In this case of giant Cystic Higroma (CH) significantly decreased after using of Doxycycline sclerotherapy for one time only without the need to repeat the procedure more than once. So clinicians should be aware of this good treatment of (CH) because it offers minimal patient trauma and excellent outcomes.

Through the good results we have reached from this case, we encourage its application extensively in the future to more cases due to their safety and quick results.

•Nowadays, surgical excision has become the less popular option for CH with high rates of complication and it has been successfully replaced with intralesional sclerotherapy as approved by many previous studies.•Our preliminary results with doxycycline sclerotherapy as an alternative form of treatment for cervical cystic hygromas are encouraging.•Adequate diagnostic workup, classification and staging of cystic lymphangiomas are paramount for proper individualized treatment selection.•The traditional absolute surgical option employed by developing countries need to be revised as the astounding recurrence rates and potential surgical morbidity can be avoided in some patients.•We injected an amount of Sclerosing material equal to half the amount withdrawn from the cyst.•we obtained a result similar to the results obtained in studies in which injections were used several times within certain intervals according to each study.

Nowadays, surgical excision has become the less popular option for CH with high rates of complication and it has been successfully replaced with intralesional sclerotherapy as approved by many previous studies.

Our preliminary results with doxycycline sclerotherapy as an alternative form of treatment for cervical cystic hygromas are encouraging.

Adequate diagnostic workup, classification and staging of cystic lymphangiomas are paramount for proper individualized treatment selection.

The traditional absolute surgical option employed by developing countries need to be revised as the astounding recurrence rates and potential surgical morbidity can be avoided in some patients.

We injected an amount of Sclerosing material equal to half the amount withdrawn from the cyst.

we obtained a result similar to the results obtained in studies in which injections were used several times within certain intervals according to each study.

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