Best treatment is surgical extirpation of all the cysts which may amount to conservative neck dissection. Those of the neck are best removed through a transverse cervical incision. Those of the axilla are excised through an incision in the maxillary crease with retraction of the pectoralis major if necessary. For cervical hygromas extending into the axilla, the cervical portion is dissected till it is seen passing below the clavicle. Then the axillary portion is dissected out through a transverse axillary incision. For Cervicomediastinal ones, transverse cervical incision is usually sufficient. Occasionally an upper sternal split may be necessary to allow excision in continuity. For Parotid hygromas,parotidectomy is not usually necessary as they don’t involve the gland.
Slow deliberate dissection with meticulous attention to anatomical detail,excellent haemostasis and wide field exposure is necessary to achieve a good cosmetic result. As they are benign swellings, normal structures in the vicinity like facial, hypoglossal and accessory nerves should not be sacrificed.
However, some success has been reported with intralesional injection of bleomycin fat emulsion and OK- 432. OK-432 (PICIBANIL) is a streptococcal lysin which was first used by Ogita and colleagues in Kyoto,Japan (1986). It acts as a biological response modifier and prepares macrophages for release of cytokines like TNF-alpha,IL-1 and CSF.It has the advantage of being used successfully in the intra uterine treatment of cystic hygroma.
Steroid injection and irradiation do not have much of a role. The recurrence rate following surgical extirpation is nearly 10 % and is noted more with those in extra parotid and suprahyoid locations.Most of the recurrences manifest within the first year and are due to residual cysts which grow with the patient. Other complications of surgery include cranial nerve palsies, cosmetic defects, dysphagia and airway compromise.
1Dr.Vijay. R, P.G.Trainee General Surgery, Room No.B-36, P.G.Annexe, Calicut Medical College,Calicut 8.
2 Dr.P.Rajan (Associate Professor), Department of General Surgery, Calicut Medical College.