Lingual localization of lymphangiomas presents a therapeutic challenge mostly because of the lesions' microcystic characteristics, which make complete surgical excision difficult if not impossible, and because of the functional problems they cause (obstruction, pain, feeding problems, edema, jaw deformities, breathing problems, and bleeding). Partial glossectomies have a high rate of relapse and can result in morphological changes in the tongue; sclerosing agents cannot be used on microcystic lesions. The use of several treatments aiming to resurface microcystic lymphatic lingual lesions with hemorrhagic vesicles, including laser and radiofrequency resurfacing (Coblation [cold plus ablation]; ArthroCare ENT, Austin, Texas), has been reported, sometimes with good results.1
Figure 1. Photographs of patient 1 before and after treatment with cold plus ablation (Coblation; ArthroCare ENT, Austin, Texas) and propranolol. A, At 15 months old, before Coblation. B, At 21 months old, 1 month after Coblation. C, At 36 months old, after recurrence of the symptoms. D, At 39 months old, 1 month after propranolol therapy was initiated. E, At 41 months old, 16 days after propranolol therapy was discontinued, with recurrence of bleeding. F, At 56 months old, the final aspect of the tongue 7 months after propranolol therapy was discontinued.
Figure 2. Patient 2 before (A) and after (B) 2 months of propranolol therapy showing disappearance of bleeding and decreased tongue size.The patient also had improvement in feeding difficulties.
Figure 3. Patient 3 before (A) and after (B) 2 months of propranolol therapy showing slight change in tongue coloration, reduced bleeding, and unchanged tongue size.
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