European Archives of Paediatric Dentistry

, Volume 13, Issue 6, pp 323–325 | Cite as

Cystic Hygroma

  • S. BarryEmail author
  • J. Allotey
  • A. M. Brundler
  • M. S. Duggal
Case Report


BACKGROUND: Cystic hygroma (CH) is a congenital malformation of the lymphatic system. It most commonly presents in the neck, and aetiological factors include environmental and genetic factors. CASE REPORT: A 13-year-old female presented with spontaneous dental pain affecting the maxillary left first and second permanent molar teeth. Medical history revealed a history of left sided cervico-facial-thoracic CH. She was diagnosed with periapical peridontitis and required extraction of both teeth. Clinical management was compromised by the CH involving the left face, neck, ear, tongue, larynx, oropharynx and mediastinum and circling the trachea and great vessels. TREATMENT: Initial management included the placement of obtundant dressings for teeth number 26 and 27 with resolution of dental pain. Intensive prevention was instigated, and teeth number 16 and 17 were restored with composite resin under local analgesia (LA) without incident. Extraction of teeth number 26 and 27 was complicated by significant trismus and the unacceptably high risk associated with general anaesthesia, due to intubation difficulties. It proved impossible to achieve satisfactory local analgesia. Due to her difficult airway, it was decided to treat the patient with inhalational sedation, but administered in an operating theatre by a consultant anaesthetist, and teeth were extracted using articaine LA. FOLLOW-UP: The patient coped well with this treatment, and was discharged home on the same day. Two year follow-up with intensive prevention showed improved oral health, with no new carious lesions detected. CONCLUSION: This is the first report to our knowledge describing dental extractions in the immediate vicinity of a cystic hygroma. A potential management strategy and the difficulties of conventional methods in such patients are discussed.

Key words

Cystic hygroma extraction anaesthesia sedation 


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  1. Ben Gamra O, Mbarek C, Neji R et al. Cervico-facial lymphangiomas. What’s the appropriate management? Tunis Med 2006; 84:721–723.Google Scholar
  2. Fleming P, Walker PO, Priest JR. Bleomycin therapy: a contraindication to the use of nitrous oxide-oxygen psychosedation in the dental office. Paediatr Dent 1998; 10:345–346.Google Scholar
  3. Gedikbasi A, Gul A, Sargin A, Ceylan Y. Cystic hygroma and lymphangioma: associated findings, perinatal outcome and prognostic factors in live-born infants. Arch Gynecol Obstet 2007; 276:491–498.PubMedCrossRefGoogle Scholar
  4. Karkos PD, Spencer MG, Lee M, Hamid BN. Cervical cystic hygroma/lymphangioma: an acquired idiopathic late presentation. J Laryngol Otol 2005; 119:561–563.PubMedCrossRefGoogle Scholar
  5. Kumar N, Kohli M, Pandey S, Tulsi S.P.S. Cystic Hygroma. Natl J Maxillofac Surg 2010; 1:81–85.PubMedCrossRefGoogle Scholar
  6. Mirza B, Ijaz L, Saleem M, Sharif M, Sheikh A. Cystic Hygroma: An Overview. J Cutan Aesthet Surg 2010; 3:139–144.PubMedCrossRefGoogle Scholar
  7. Mirza B, Ijaz L, Iqbal S et al. Cystic Hygroma of unusual sites: Report of two cases. Afr J Paediatr Surg 2011; 8:85–88.PubMedCrossRefGoogle Scholar
  8. Mosca R, Pereira G, Mantesso A. Cystic hygroma: characterization by computerized tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105:e65–e69.PubMedCrossRefGoogle Scholar
  9. Okada A, Kubota A, Fukuzawa M, Imura K, Kamata S. Injection of bleomycin as a primary therapy of cystic lymphangioma. J Pediatr Surg 1992; 27:440–443.PubMedCrossRefGoogle Scholar
  10. Padwa BL, Hayward PG, Ferraro NF et al. Cervicofacial lymphatic malformation: clinical course, surgical intervention and pathogenesis of skeletal hypertrophy. Plastic Reconstruct Surg 1995; 95:951–960.CrossRefGoogle Scholar
  11. Rautio R, Keski-Nisula L, Laranne J et al. Treatment of Lymphangiomas with OK-432 (Picibanil). Cardiovasc Intervent Radiol 2003; 26:31–36.PubMedCrossRefGoogle Scholar
  12. Srinivasan N, Kavitha M, Loganathan CS, Padmini. Comparison of anesthetic efficacy of 4% articaine and 2% lidocaine for maxillary buccal infiltration in patients with irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107:133–136.PubMedCrossRefGoogle Scholar
  13. Velez I, Mintz S. Cystic Hygroma Case Report. N Y State Dent J 2006: 72:51–52.Google Scholar

Copyright information

© European Academy of Paediatric Dentistry 2012

Authors and Affiliations

  • S. Barry
    • 1
    Email author
  • J. Allotey
    • 2
  • A. M. Brundler
    • 2
  • M. S. Duggal
    • 1
  1. 1.Department of Paediatric DentistryLeeds Dental InstituteLeedsUK
  2. 2.Histopathology DepartmentBirmingham Children’s HospitalBirminghamUK

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