Transmucosal Bleomycin for Tongue Lymphatic Malformations
Affiliation(s)
1 Department of Otolaryngology, New York University, New York, USA. 2 Vascular Birthmark Institute of New York, Lenox Hill and Manhattan Eye, Ear and Throat Hospitals, New York, USA.
1 Department of Otolaryngology, New York University, New York, USA. 2 Vascular Birthmark Institute of New York, Lenox Hill and Manhattan Eye, Ear and Throat Hospitals, New York, USA.
ABSTRACT
Purpose: Bleomycin is an antibiotic medication that inhibits the synthesis of DNA, RNA, and proteins and is now used in a variety of medical conditions including vascular anomalies. The aim of this study was to evaluate the clinical efficacy of transmucosal intralesional injection of bleomycin in the management of tongue lymphatic malformations. Method: A single institutional case series was presented on patients with recalcitrant lymphatic malformations of the tongue who were treated with bleomycin. Age at the time of injection, gender, number of treatments, amount of bleomycin injected per session, post-injection complications, pre- and post-injection symptoms, and anatomic extent of the lymphatic malformation were all recorded and analyzed. Results: Five patients received transmucosal bleomycin and were followed over a 10-month period. The patients included 4 females and 1 male, aged from 3.25 to 36 years (average 13.52 years). Four patients had one treatment while 1 required two treatments. A total of 1 to 6 units were injected per session. Overall reduction in size of the lymphatic malformation and improvement in all symptoms were observed in the patients by day 14. Average follow-up was 9 to 12 months. Conclusion: Intralesional injection of bleomycin is an effective treatment modality in patients with lymphatic malformations of the tongue.
Purpose: Bleomycin is an antibiotic medication that inhibits the synthesis of DNA, RNA, and proteins and is now used in a variety of medical conditions including vascular anomalies. The aim of this study was to evaluate the clinical efficacy of transmucosal intralesional injection of bleomycin in the management of tongue lymphatic malformations. Method: A single institutional case series was presented on patients with recalcitrant lymphatic malformations of the tongue who were treated with bleomycin. Age at the time of injection, gender, number of treatments, amount of bleomycin injected per session, post-injection complications, pre- and post-injection symptoms, and anatomic extent of the lymphatic malformation were all recorded and analyzed. Results: Five patients received transmucosal bleomycin and were followed over a 10-month period. The patients included 4 females and 1 male, aged from 3.25 to 36 years (average 13.52 years). Four patients had one treatment while 1 required two treatments. A total of 1 to 6 units were injected per session. Overall reduction in size of the lymphatic malformation and improvement in all symptoms were observed in the patients by day 14. Average follow-up was 9 to 12 months. Conclusion: Intralesional injection of bleomycin is an effective treatment modality in patients with lymphatic malformations of the tongue.
Cite this paper
Cerrati, E. , O., T. M. , Binetter, D. , Bernstein, Y. and Waner, M. (2015) Transmucosal Bleomycin for Tongue Lymphatic Malformations. International Journal of Otolaryngology and Head & Neck Surgery, 4, 81-85. doi: 10.4236/ijohns.2015.42015.
Cerrati, E. , O., T. M. , Binetter, D. , Bernstein, Y. and Waner, M. (2015) Transmucosal Bleomycin for Tongue Lymphatic Malformations. International Journal of Otolaryngology and Head & Neck Surgery, 4, 81-85. doi: 10.4236/ijohns.2015.42015.
References
[1] Oomen, K.P., Paramasivam, S., Waner, M., et al. Endoscopic Transmucosal Direct Puncture Sclerotherapy for Management of Airway Vascular Malformations. Pending Publication. [2] Gurgacz, S., Zamora, L. and Scott, A. (2014) Percutaneous Sclerotherapy for Vascular Malformations: A Systemic Review. Annals of Vascular Surgery, 28, 1335-1349.
http://dx.doi.org/10.1016/j.avsg.2014.01.008 [3] Burrows, P.E., Mitri, R.K., Alomari, A., et al. (2008) Percutaneous Sclerotherapy of Lymphatic Malformations with Doxycycline. Lymphatic Research and Biology, 6, 209-216.
http://dx.doi.org/10.1089/lrb.2008.1004 [4] O, T.M., Rickert, S.M., Diallo, A.M., et al. (2013) Lymphatic Malforma-tions of the Airway. Otolaryngology—Head and Neck Surgery, 149, 156-160.
http://dx.doi.org/10.1177/0194599813485065 [5] Wiegand, S., Eivazi, B., Zimmermann, A., et al. (2009) Microcystic Lymphatic Malformations of the Tongue: Diagnosis, Classification, and Treatment. Archives of Otolaryngology—Head and Neck Surgery, 135, 976-983.
http://dx.doi.org/10.1001/archoto.2009.131 [6] Bai, Y., Jia, J., Huang, X.X., et al. (2009) Sclerotherapy of Microcystic Lymphatic Malformations in Oral and Facial Regions. Journal of Oral and Maxillofacial Surgery, 67, 251-256.
http://dx.doi.org/10.1016/j.joms.2008.06.046 [7] Mathur, N.N., Rana, I., Bothra, R., et al. (2005) Bleomycin Sclero-therapy in Congenital Lymphatic and Vascular Malformations of Head and Neck. International Journal of Pediatric Otor-hinolaryngology, 69, 75-80.
http://dx.doi.org/10.1016/j.ijporl.2004.08.008 [8] Jules-Elysee, K. and White, D.A. (1990) Bleomycin-Induced Pul-monary Toxicity. Clinics in Chest Medicine, 11, 1-20. [9] Ionescu, G., Mabeta, P., Dippenaar, N., et al. (2008) Bleomycin Plasma Spill-Over Levels in Pediatric Patients Undergoing Intralesional Injection for the Treatment of Hemangiomas. South African Medical Journal, 98, 539-540. [10] Khenaizan, S. and Al-Berouti, B. (2011) Flagellate Pigmentation: A Unique Adverse Side Effect of Bleomycin Therapy. European Journal of Dermatology, 21, 146.
[1] Oomen, K.P., Paramasivam, S., Waner, M., et al. Endoscopic Transmucosal Direct Puncture Sclerotherapy for Management of Airway Vascular Malformations. Pending Publication. [2] Gurgacz, S., Zamora, L. and Scott, A. (2014) Percutaneous Sclerotherapy for Vascular Malformations: A Systemic Review. Annals of Vascular Surgery, 28, 1335-1349.
http://dx.doi.org/10.1016/j.avsg.2014.01.008 [3] Burrows, P.E., Mitri, R.K., Alomari, A., et al. (2008) Percutaneous Sclerotherapy of Lymphatic Malformations with Doxycycline. Lymphatic Research and Biology, 6, 209-216.
http://dx.doi.org/10.1089/lrb.2008.1004 [4] O, T.M., Rickert, S.M., Diallo, A.M., et al. (2013) Lymphatic Malforma-tions of the Airway. Otolaryngology—Head and Neck Surgery, 149, 156-160.
http://dx.doi.org/10.1177/0194599813485065 [5] Wiegand, S., Eivazi, B., Zimmermann, A., et al. (2009) Microcystic Lymphatic Malformations of the Tongue: Diagnosis, Classification, and Treatment. Archives of Otolaryngology—Head and Neck Surgery, 135, 976-983.
http://dx.doi.org/10.1001/archoto.2009.131 [6] Bai, Y., Jia, J., Huang, X.X., et al. (2009) Sclerotherapy of Microcystic Lymphatic Malformations in Oral and Facial Regions. Journal of Oral and Maxillofacial Surgery, 67, 251-256.
http://dx.doi.org/10.1016/j.joms.2008.06.046 [7] Mathur, N.N., Rana, I., Bothra, R., et al. (2005) Bleomycin Sclero-therapy in Congenital Lymphatic and Vascular Malformations of Head and Neck. International Journal of Pediatric Otor-hinolaryngology, 69, 75-80.
http://dx.doi.org/10.1016/j.ijporl.2004.08.008 [8] Jules-Elysee, K. and White, D.A. (1990) Bleomycin-Induced Pul-monary Toxicity. Clinics in Chest Medicine, 11, 1-20. [9] Ionescu, G., Mabeta, P., Dippenaar, N., et al. (2008) Bleomycin Plasma Spill-Over Levels in Pediatric Patients Undergoing Intralesional Injection for the Treatment of Hemangiomas. South African Medical Journal, 98, 539-540. [10] Khenaizan, S. and Al-Berouti, B. (2011) Flagellate Pigmentation: A Unique Adverse Side Effect of Bleomycin Therapy. European Journal of Dermatology, 21, 146.