Cystic hygroma is a developmental malformation of the lymphatic system found most often in the posterior triangle of the neck and axilla of children. They are divided into suprahyoid and subhyoid masses. They are compressible masses that are most often found in infants younger than 1 year and can intermittently enlarge. Suprahyoid masses can be extremely difficult to manage because of the associated obstructive symptoms, feeding difficulties, and potential for infection, which can compromise airway patency. Surgical removal is the treatment of choice, but complete surgical removal of these masses is often impossible. Repeat debulking is sometimes the only treatment. The mortality of a prenatally diagnosed cystic hygroma remains high, due to other comorbidities and the risk of airway obstruction. Therefore, tracheal intubation at delivery while maintaining uninterrupted maternal-fetal circulation until the airway is secured (ex utero intrapartum treatment [EXIT] procedure) has been performed to prevent the fatal consequences of immediate postnatal airway obstruction. Other treatment modalities include radiofrequency ablation, CO₂ laser therapy, and percutaneous sclerotherapy. Bleomycin, doxycycline, OK432, and tetracycline have been used as sclerosing agents with favorable results.

References

• Behera S, Bawa M, Kanojia RP, Saha PK, Singh T, Samujh R. Outcome of antenatally diagnosed cystic hygroma—lessons learnt. Int J Pediatr Otorhinolaryngol. 2020;138:110227.
• Boruga VM, Szilagyi DN, Prodea M, et al. Cystic hygroma of the neck-case report. Rom J Morph Embryol. 2021;62:845-848.
• Damaskos C, Garmpis N, Manousi M, et al. Cystic hygroma of the neck: single center experience and literature review. Eur Rev Med Pharmacol Sci. 2017;21:4918-4923.
• Laje P, Tharakan SJ, Hedrick HL. Immediate operative management of the fetus with airway anomalies resulting from congenital malformations. Semin Fetal Neonatal Med. 2016;21:240-245.
• Levine MC, Arroyo A, Likourezos A, Homel P, Dickman E. The use of point of care ultrasound in the evaluation of pediatric soft tissue neck masses. Am J Emerg Med. 2019;37:1466-1469.