cervical cystic lymphangioma resection

The cystic lymphangioma of the neck (saccular hemangio) grows around the blood vessels, nerves or into the muscle layer and has a tendency to infect. Most of the supraclavicular fossa located on the lateral side of the neck and the posterior triangle of the neck. Extending to the periphery, the sternocleidomastoid deep into the mediastinum, extending along the brachial plexus to the armpit or back to the scapula, extending around the carotid sheath to the trachea, esophagus, or through the mandibular angle to the parotid gland . Cystic lymphangioma consists of a single or multiple cysts of varying sizes, isolated or connected. The cysts are mostly round or elliptical, smooth, soft, and irregular in the edges. The wall of the capsule is thin and transparent, lined with a flat epithelium, with a pale yellow clarified lymph in the cavity, and old bloody when there is bleeding, and the wall of the capsule is generally non-adhesive to the skin. Treatment of diseases: cystic lymphangioma neck cystic lymphangioma Indication The cystic lymphangioma of the neck continues to grow and oppress, resulting in difficulty in breathing and swallowing, and can be repeatedly infected and hemorrhage. Surgical resection of the entire tumor is an effective cure. In the case of anesthesia and surgical conditions, the sick child can undergo cystic lymphangioma resection in the neck 5 to 6 months after birth. If the lumps compress the trachea and cause severe breathing difficulties, surgery should be performed as soon as possible. If necessary, an emergency tracheotomy should be performed first, and then the tumor should be removed selectively. Contraindications 1. The tumor is closely related to the adjacent important tissue structure, and it is expected that the resection will bring serious dysfunction. 2. Cyst infection is uncontrolled. Preoperative preparation 1. Control the infection of cystic lymphangioma. 2. Fully estimate the extent of possible invasion of the lesion and the difficulty of resection. Ensure a good intravenous infusion pathway. Surgical procedure Anesthesia and position General anesthesia with endotracheal intubation. Intratracheal intubation can be quickly induced without respiratory compression, and awake intubation should be considered if there is tracheal compression. The sick child is lying on his back, and the soft pillow is placed under the shoulder to extend the neck and turn the head to the opposite side. Surgical procedure Incision When the tumor is small, a transverse incision or an arc incision can be made along the dermatoglyph; a large cyst can be made into a fusiform incision, and the ends are up to the edge of the tumor, and part of the skin is removed. 2. Separation of cysts Tumors often have intact capsules that are non-adhesive to the skin, and are separated and ligated along the envelope into small blood vessels of the cyst. The tumor wall is thin and can not be clamped to avoid peeling, so that the fluid overflow can increase the difficulty of peeling off. The gauze can be used to push the wall to identify the boundary. Cysts may have finger-like protrusions extending along the fascial space. In particular, they should be adhered to the carotid sheath or the posterior accessory nerve on the deep side of the sternocleidomastoid muscle. If necessary, retract or cut the sternocleidomastoid muscle and open. Carotid sheath, recognize the above important structure, and carefully separate the tumor. The thin internal jugular vein wall is extremely vulnerable and must be taken care of. When the tumor surrounds the trachea and esophagus, care should be taken to protect the vagus nerve and recurrent laryngeal nerve. The cyst enters the mediastinum via the supraclavicular fossa and sometimes the clavicle must be severed. When the situation is not allowed to expand the surgery, the cyst in the mediastinum can be left for the second stage of surgery. The cyst involves the parotid gland and must avoid damage to the facial nerve causing permanent facial deformities. When there are difficulties, it is better to keep a little wall. The residual capsule wall can be rubbed with 2% iodine to destroy its inner membrane. 3. Stitching and drainage The filament line sutures the platysma and skin layer by layer, and the rubber sheet is placed in the cavity to compress the dressing or to put the latex tube under vacuum suction.

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