Delaying Invasive Treatment in Unilateral Head and Neck Lymphatic Malformation Improves Outcomes

Objectives Large (De Serres stage [IV–V]) head and neck lymphatic malformations (HNLMs) often have multiple, high‐risk, invasive treatments (ITs) to address functional compromise. Logically reducing HNLM ITs should reduce treatment risk. We tested whether delaying HNLM ITs reduces total IT number. Materials Consecutive HNLM patients (n = 199) between 2010 and 2017, aged 0–18 years. Methods ITs (surgery or sclerotherapy) were offered for persistent or dysfunction causing HNLMs. Treatment effectiveness categorized by IT number: optimal (0–1), acceptable (2–5), or suboptimal (>5). Clinical data were summarized, and outcome associations tested (χ2). Relative risk (RR) with a Poisson working model tested whether HNLM observation or IT delay (>6 months post‐diagnosis) predicts treatment success (i.e., ≤1 IT). Results Median age at HNLM diagnosis was 1.3 months (interquartile range [IQR] 0–45 m) with 107/199(54%) male. HNLM were stage I–III (174 [88%]), IV–V (25 [13%]). Initial treatment was observation (70 [35%]), invasive (129 [65%]). Treatment outcomes were optimal (137 [69%]), acceptable (36 [18%]), and suboptimal (26 [13%]). Suboptimal outcome associations: EXIT procedure, stage IV–V, oral location, and tracheotomy (p 1 IT], RR = 0.09, 95% CI 0.02–0.36, p