Case Report
Doxycycline Sclerotherapy of a Cervical Cystic Hygroma: A
Caribbean Institution Experience
Nicholas Figaro ,
1
Robbie Rampersad,
2
and Solaiman Juman
1
1
Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champs Fleur,
Trinidad and Tobago
2
Department of Radiology, University of the West Indies, Eric Williams Medical Sciences Complex, Champs Fleur,
Trinidad and Tobago
Correspondence should be addressed to Nicholas Figaro; nicholasfigaro@gmail.com
Received 17 September 2019; Revised 17 August 2020; Accepted 29 August 2020; Published 15 September 2020
Academic Editor: Dinesh K. Chhetri
Copyright © 2020 Nicholas Figaro et al. is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cervical cystic lymphangiomas are rare benign tumors that pose a formidable challenge to surgeons confronted with managing
this uncommon entity. Due to the intimacy with which these cystic lesions blend with critical cervical structures, a considerable
number of patients who undergo surgical management are often plagued with recurrence and morbidity. As a result, doxycycline
sclerotherapy has become an attractive, safe, and effective alternative as a primary treatment modality in a select group of pediatric
patients. is case report presents an 18-month-old patient with a large cervical cystic hygroma that was effectively treated with
exclusive doxycycline sclerotherapy.
1. Introduction
Cystic hygroma, a cystic subtype of lymphangioma, is a
congenital benign lymphatic malformation. It is considered a
relatively rare lesion having an incidence of 1 in 2000–4000 live
births [1]. ough not fully understood, cystic lymphangiomas
are thought to arise from errors with signaling during em-
bryogenesis of the lymphatic system, resulting in abnormal
lymphatic channels and cystic spaces of various sizes [2]. Cystic
lymphangiomas can manifest at any age, with 50% of the cases
present at birth and 90% by the end of infancy [3]. Approx-
imately 80% of cystic hygromas occur in the cervicofacial
region although they can manifest throughout the body [4].
Several classification systems have been proposed to aid in
diagnosing and managing cystic hygromas. Smith and col-
leagues described the cystic lymphangiomas as either macro-
cystic, microcystic, or mixed, depending on radiological
findings. Macrocysts were defined as lesions with cystic con-
tents of at least 2 cm
3
in volume, whereas microcysts contained
lesions less than 2 cm
3
. Furthermore, this classification is also
capable of predicting the response to sclerotherapy [5]. de
Serres et al. also proposed a classification system based on the
anatomic location of the lymphatic malformation in relation to
the hyoid. is allowed for prognostication and estimation of
the surgical complication rate [6].
Historically, surgery has been the cornerstone of treatment,
but the total excision of the lymphangioma can lead to severe
complications such as neurovascular injury and cosmetic de-
formity. Recent evidence has shown that macrocytic lym-
phangiomas treated with surgical excision also respond very
well to percutaneous sclerotherapy with less surgical morbidity
[7, 8]. e case report in this paper presents an 18-month-old
male with a large cervical cystic hygroma which was suc-
cessfully treated with doxycycline sclerotherapy by the Oto-
laryngology Department at Eric Williams Medical Sciences
Complex (EWMSC), Trinidad and Tobago. is is the first case
report of doxycycline sclerotherapy of a cystic hygroma from
the English-speaking Caribbean.
2. Case Report
An 18-month-old male was referred to the Department of
Otolaryngology by his pediatrician for an asymptomatic,
aesthetically unappealing swelling. e patient’s mother
Hindawi
Case Reports in Otolaryngology
Volume 2020, Article ID 9187205, 5 pages
https://doi.org/10.1155/2020/9187205