Surgery Today

, Volume 49, Issue 5, pp 410–419 | Cite as

Indications for tracheostomy in children with head and neck lymphatic malformation: analysis of a nationwide survey in Japan

  • Shigeru UenoEmail author
  • Akihiro Fujino
  • Yasuhide Morikawa
  • Tadashi Iwanaka
  • Yoshiaki Kinoshita
  • Michio Ozeki
  • Shunsuke Nosaka
  • Kentaro Matsuoka
  • Noriaki Usui
Original Article



Airway obstruction caused by lymphatic malformation (LM) in the head and neck may require a tracheostomy. We present the results of our analysis of a nationwide survey on the indications for tracheostomy in children with head and neck LM.


We analyzed data in relation to tracheostomy based on a questionnaire about 518 children with head and neck LM without mediastinal involvement.


Tracheostomy was performed for 43 of the 518 children. Most (32/43) of these children were younger than 1 year of age and the tracheostomy was almost always performed for airway obstruction (40/43). The lesion was in contact with the airway in 32 (72%) of these children, but in only 58 (12%) of the 473 children who were managed without tracheostomy. When the maximum circumferential area of contact was compared, only 20 (27%) of 74 patients with maximum contact of less than a half-circle required tracheostomy, whereas 11 of 13 with maximum contact of more than a half-circle required tracheostomy (P = 0.0001). Six patients without airway contact required tracheostomy because of acute swelling caused by hemorrhage, infection, or both.


Children with head and neck LM required tracheostomy to relieve airway obstruction. Tracheostomy should be considered if the lesion is in contact with the airway and surrounds more than a half-circle, and when it causes acute swelling.


Lymphangioma Lymphatic malformation Neck Tracheostomy Management 



This study was supported by a grant for a Research Project for Intractable Diseases by the Ministry of Health, Labor and Welfare in Japan (Grant no. 26070201) received by N.U., and by the Practical Research Project for Rare/Intractable Disease from Japan Agency for Medical Research and Development, AMED, received by A.F.

Compliance with ethical standards

Conflict of interest

We have no conflicts of interest to declare.


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Shigeru Ueno
    • 1
    Email author
  • Akihiro Fujino
    • 2
  • Yasuhide Morikawa
    • 3
  • Tadashi Iwanaka
    • 4
  • Yoshiaki Kinoshita
    • 5
  • Michio Ozeki
    • 6
  • Shunsuke Nosaka
    • 7
  • Kentaro Matsuoka
    • 8
  • Noriaki Usui
    • 9
  1. 1.Department of Pediatric SurgeryTokai University School of MedicineIseharaJapan
  2. 2.Department of Pediatric SurgeryNational Center for Child Health and DevelopmentTokyoJapan
  3. 3.Department of Pediatric SurgeryInternational University of Health and WelfareNasushiobaraJapan
  4. 4.Department of Pediatric SurgeryThe University of Tokyo Faculty of MedicineTokyoJapan
  5. 5.Department of Pediatric SurgeryNiigata University School of MedicineNiigataJapan
  6. 6.Department of PediatricsGifu University HospitalGifuJapan
  7. 7.Department of RadiologyNational Center for Child Health and DevelopmentTokyoJapan
  8. 8.Department of PathologyDokkyo Medical University Koshigaya HospitalKoshigayaJapan
  9. 9.Department of Pediatric SurgeryOsaka Women’s and Children’s HospitalIzumiJapan

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