Management of a giant cystic hygroma with restricted neck extension in a child with pediatric King Vision® video laryngoscope
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Cystic hygroma, a type of lymphangioma, is a benign congenital malformation of the lymphatic system that commonly involves the cervical and facial regions (Fonkalsrud 2006).
Anesthetic management of huge cystic hygroma excision poses considerable challenge because of the involvement of the airway and intraoperative blood loss (Mirza et al. 2010). We describe the successful management of a child having restricted neck extension due to huge cystic hygroma involving the neck and chest after obtaining a written consent from the child’s parents.
Complete surgical excision is the preferred treatment modality for cystic hygroma, though other modalities such as sclerotherapy and radio frequency ablation may produce variable results (Mirza et al. 2010). Our patient had an antenatal diagnosis and though the parents were advised about the surgical treatment at the earliest, they refused to give consent for the surgery. The tumor progressively increased its size and debilitated the child’s growth and development making him bedridden and finally the parents gave consent. Because of the enormity of the size and involvement of the neck and chest, we anticipated a difficult airway and massive intraoperative blood loss. King Vision® video laryngoscope can be a useful and safe alternative to pediatric fiberoptic bronchoscope in this type of case when there is restricted neck extension due to a large mass involving the side of the neck and chest. Maintenance of a spontaneous ventilation remains the most crucial step. Cystic hygroma can infiltrate the underlying structures and can cause significant blood loss duding complete excision (Esmaeili et al. 2009). Adequate crossmatched blood products should be available intraoperatively. A meticulously planned strategy for securing the airway and emphasis on fluid management and good postoperative care is the crux of anesthetic management of cystic hygroma. King Vision® video laryngoscope can be useful in these scenarios.
Consent to participate
Written consent obtained from child’s parents.
GS was responsible for the manuscript preparation, manuscript editing, literature search, and intellectual content. SLG contributed to the manuscript review and intellectual content. DC was responsible for the manuscript preparation and literature search. All authors read and approved the final manuscript.
Consent for publication
Consent was obtained from the child’s parents.
The authors declare that they have no competing interests.
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