Lymphangiomas are benign tumors of lymphatic vessels that most commonly occur in the head and neck region, particularly the tongue. They can also occasionally be found in the oral cavity elsewhere like the palate, cheeks, or lips. Lymphangiomas are generally classified as simple, cavernous, cellular, or diffuse systemic and can be either cystic or microcystic/macrocystic. Treatment options include surgical excision, sclerotherapy, cryotherapy, laser therapy, and other conservative treatments. Complete surgical removal is often difficult due to the risk of damaging surrounding vital structures and high chance of recurrence.

1. LYMPHANGIOMA
 Lymphangiomas are benign tumours of lymphatic
vessels showing marked predilection for head and
neck region.

2. •They are extremely rare in
the oral cavity.
• The common site of
occurrence for lymphangioma
in the oral cavity is the anterior
dorsum and lateral border of
tongue.

3.  Other parts of oral
cavity such as the
palate, cheeks, floor of
the mouth, gingiva and
lips.

4. Classification of lymphangioma,
Watson and McCarthy
1) Simple lymphangioma
2) Cavernous lymphangioma
3) Cellular lymphangioma
4) Diffuse systemic lymphangioma
1) Cystic lymphangioma

5.  LM divided into two types
 1. Macrocystic
 2.Microcystic Superficial seated
Deep seated

6.  Serres et al.
 A staging system based on the location and
extent of the lesions:
 stage I is unilateral infrahyoid,
 stage II is unilateral suprahyoid,
 stage III is unilateral infrahyoid and suprahyoid,
 stage IV is bilateral infrahyoid,
 stage V is bilateral infrahyoid and suprahyoid.

7. Management of lymphangioma
 Various methods have been reported for the
treatment of lymphangiomas.
Procedures such as
 1)Surgical excision
 2)Radiation therapy,
 3)Cryotherapy,

8. 4)Electrocautery,
5)Sclerotherapy,
6)Steroid administration,
7)Embolisation,
8)Ligation,
9) Laser surgery

9.  Conservative treatments including radiotherapy,
electrocoagulation, cryotherapy, ligation,
embolization, sclerotherapy and laser therapy
have been recommended as a primary or adjunctive
treatment for lymphangioma.

10. LASER THERAPY-
 Carbon dioxide (CO2) laser is the most commonly
used laser for treatment of lymphangioma due
to its affinity with water and high absorption by the
oral mucosa.

11.  The interaction of the laser light with the tissue
occurs by the transformation of the light into heat
in the presence of fluids, mainly water.
 Besides CO2 laser, Nd:YAG laser, pulsed dye laser
and diode laser can also be used.

12. Advantage of laser in lymphangioma
 Coagulation of small blood vessels and lymphatic
vessels, making the surgical field drier.
 Reducing the risk of metastasis.
 Decreasing postoperative pain and discomfort due
to the formation of thermal neuromas at the nerve
endings.

13.  Immediate sterilization of wound surface due to
the high temperature generated during the
irradiation.
 Minimal or no wound contraction and scarring due
to the presence of small amount of myofibroblasts.
 No need of sutures or wound dressings,

14. Disadvantages of laser in lymphangioma
 Slightly delay on wound healing that occurs due to
the thermal damage around the irradiation site.
 High cost of the equipment,
 Need of surgeon training on laser use

15. Sclerotherapy
 Intralesional injections of sclerosing agents such
as 25% dextrose, hypertonic saline, bleomycin,
aethoxysklerol, or OK-432 (picibanil) are
recommended for treatment of lymphangioma.

16.  Eight milligrams of Pingyangmycin powder is
dissolved in 5 mL normal saline with addition of 2
mL 2% lidocaine hydrochloride and 1 mL
dexamethasone.
 The dosage per injection is 1 mL/cm2 of the lesion
as determined by clinical measurement,
 The maximal dose for one injection is 8 mg, and
the total dose should not exceed 40 mg in an adult
patient.

17. Disadvantage
 Very few patients develop low grade fever,
 loss of appetite and skin rash.

18. Cryosurgery
 Cryotherapy, also known as cryosurgery, is a
commonly used for the treatment of
lymphangioma..
The mechanism of destruction in cryotherapy is:
 Intracellular ice formation that leads to cell
rupture.

19.  An increase in solute concentration within
the damaged tissue.
 Inflammation in the damaged tissue.
 Liquid nitrogen apparatus (CRY-AC; Brymill,
Ellington, CT, USA) was used to perform the
cryotherapy.

20.  Lymphangiomas are thought to be very suitable for
treatment by cryosurgery because of their high
fluid content and poor blood supply.

21. Surgical management
 Complete surgical excision remains the most
accepted treatment option for lymphangioma.
 Most adult lymphangiomas are encapsulated or
partially circumscribed and thus surgical removal is
facilitated

22.  Successful treatment requires the inclusion of a
surrounding border of normal tissue, provided that
vital structures are not damaged.

23. Complication of surgery
 Damage to surrounding vital structures, nerves and
blood vessels,
 Prolonged lymphatic drainage from the wound,
wound infections, and unacceptable scar formation
 The chances of recurrence following the surgery
may be high, (10% to 38%)

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