Interdisciplinary Treatment of Macroglossia Due to a Microcystic Lymphatic Malformation with Bleomycin Electrosclerotherapy Followed by Partial Resection

Excerpt

Lymphatic malformations are rare congenital vascular anomalies. Treatment remains challenging due to their varying localization and their different morphology especially if located on the tongue. In addition to the typical symptoms, such as pain and recurrent infections, small lymphatic blebs on the surface of the tongue, macroglossia is a particular problem due to accompanying localized soft tissue hyperplasia making mouth closure und eating difficult. In addition, it may be difficult to reach the dorsal and basal parts for the lesion for treatment via direct puncture [1]. The current state-of-the-art treatment of lymphatic malformations is intralesional injection of a sclerosing agent. A new form of therapy is the combination of bleomycin injections followed by reversible electroporation. The application of short electric pulses temporarily increases the cell permeability, allowing for a higher intracellular bleomycin concentration and thus to use lower bleomycin doses overall, as well as reducing the risk of possible side effects. First studies have proven the effectiveness of this new form of therapy applied to different kinds of malformations [2, 3]. …