New onset dysphagia and pulmonary aspiration following sclerotherapy for a complex cervical venolymphatic malformation in an infant: Case report and review of the literature

Douglas Robert Johnston*, James S Donaldson, A. M. Cahill

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

We present the case of a 2-year-old male with a complex left cervical venolymphatic malformation who underwent doxycycline sclerotherapy at 12 months of age complicated by new onset pulmonary aspiration. A review of the literature reveals this to be a rare complication of sclerotherapy and only the second reported case. Methods: Procedural details with associated imaging including endoscopic airway and swallowing evaluation are included. A literature review of cervical and laryngeal sclerotherapy complications was performed and discussed. Results: A 12-month-old male underwent sclerotherapy with doxycycline for a complex parapharyngeal and paralaryngeal venolymphatic malformation. The postoperative course was complicated by new onset dysphagia, aspiration, and decreased laryngeal sensation. Gastric feeding and swallowing therapy were necessary due to prolonged difficulty. The sclerotherapy treatment resulted in near elimination of the cervical components of the lesion at 12 months follow up. The child progressed to total oral feeding by 17 months post-treatment with no evidence of decreased laryngeal sensation. An extensive literature review identified only one reported case of new onset dysphagia and decreased laryngeal sensation after doxycycline sclerotherapy. Conclusions: Doxycycline sclerotherapy for cervical venolymphatic malformations rarely can cause adjacent neural injury resulting in laryngeal complications. Our case report and literature review suggest that symptom management and appropriate aspiration precautions are necessary in infants or children with presumed vagus or laryngeal nerve injury, and injury is likely only temporary.

Original languageEnglish (US)
Article number109694
JournalInternational journal of pediatric otorhinolaryngology
Volume128
DOIs
StatePublished - Jan 1 2020

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Sclerotherapy
Deglutition Disorders
Doxycycline
Lung
Deglutition
Vagus Nerve Injuries
Laryngeal Nerve Injuries
compound A 12
Wounds and Injuries
Aspirations (Psychology)
Stomach
Therapeutics

Keywords

  • Aspiration
  • Dysphagia
  • Lymphatic malformation
  • Neuropathy
  • Sclerotherapy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Otorhinolaryngology

Cite this

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title = "New onset dysphagia and pulmonary aspiration following sclerotherapy for a complex cervical venolymphatic malformation in an infant: Case report and review of the literature",
abstract = "We present the case of a 2-year-old male with a complex left cervical venolymphatic malformation who underwent doxycycline sclerotherapy at 12 months of age complicated by new onset pulmonary aspiration. A review of the literature reveals this to be a rare complication of sclerotherapy and only the second reported case. Methods: Procedural details with associated imaging including endoscopic airway and swallowing evaluation are included. A literature review of cervical and laryngeal sclerotherapy complications was performed and discussed. Results: A 12-month-old male underwent sclerotherapy with doxycycline for a complex parapharyngeal and paralaryngeal venolymphatic malformation. The postoperative course was complicated by new onset dysphagia, aspiration, and decreased laryngeal sensation. Gastric feeding and swallowing therapy were necessary due to prolonged difficulty. The sclerotherapy treatment resulted in near elimination of the cervical components of the lesion at 12 months follow up. The child progressed to total oral feeding by 17 months post-treatment with no evidence of decreased laryngeal sensation. An extensive literature review identified only one reported case of new onset dysphagia and decreased laryngeal sensation after doxycycline sclerotherapy. Conclusions: Doxycycline sclerotherapy for cervical venolymphatic malformations rarely can cause adjacent neural injury resulting in laryngeal complications. Our case report and literature review suggest that symptom management and appropriate aspiration precautions are necessary in infants or children with presumed vagus or laryngeal nerve injury, and injury is likely only temporary.",
keywords = "Aspiration, Dysphagia, Lymphatic malformation, Neuropathy, Sclerotherapy",
author = "Johnston, {Douglas Robert} and Donaldson, {James S} and Cahill, {A. M.}",
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AU - Donaldson, James S

AU - Cahill, A. M.

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N2 - We present the case of a 2-year-old male with a complex left cervical venolymphatic malformation who underwent doxycycline sclerotherapy at 12 months of age complicated by new onset pulmonary aspiration. A review of the literature reveals this to be a rare complication of sclerotherapy and only the second reported case. Methods: Procedural details with associated imaging including endoscopic airway and swallowing evaluation are included. A literature review of cervical and laryngeal sclerotherapy complications was performed and discussed. Results: A 12-month-old male underwent sclerotherapy with doxycycline for a complex parapharyngeal and paralaryngeal venolymphatic malformation. The postoperative course was complicated by new onset dysphagia, aspiration, and decreased laryngeal sensation. Gastric feeding and swallowing therapy were necessary due to prolonged difficulty. The sclerotherapy treatment resulted in near elimination of the cervical components of the lesion at 12 months follow up. The child progressed to total oral feeding by 17 months post-treatment with no evidence of decreased laryngeal sensation. An extensive literature review identified only one reported case of new onset dysphagia and decreased laryngeal sensation after doxycycline sclerotherapy. Conclusions: Doxycycline sclerotherapy for cervical venolymphatic malformations rarely can cause adjacent neural injury resulting in laryngeal complications. Our case report and literature review suggest that symptom management and appropriate aspiration precautions are necessary in infants or children with presumed vagus or laryngeal nerve injury, and injury is likely only temporary.

AB - We present the case of a 2-year-old male with a complex left cervical venolymphatic malformation who underwent doxycycline sclerotherapy at 12 months of age complicated by new onset pulmonary aspiration. A review of the literature reveals this to be a rare complication of sclerotherapy and only the second reported case. Methods: Procedural details with associated imaging including endoscopic airway and swallowing evaluation are included. A literature review of cervical and laryngeal sclerotherapy complications was performed and discussed. Results: A 12-month-old male underwent sclerotherapy with doxycycline for a complex parapharyngeal and paralaryngeal venolymphatic malformation. The postoperative course was complicated by new onset dysphagia, aspiration, and decreased laryngeal sensation. Gastric feeding and swallowing therapy were necessary due to prolonged difficulty. The sclerotherapy treatment resulted in near elimination of the cervical components of the lesion at 12 months follow up. The child progressed to total oral feeding by 17 months post-treatment with no evidence of decreased laryngeal sensation. An extensive literature review identified only one reported case of new onset dysphagia and decreased laryngeal sensation after doxycycline sclerotherapy. Conclusions: Doxycycline sclerotherapy for cervical venolymphatic malformations rarely can cause adjacent neural injury resulting in laryngeal complications. Our case report and literature review suggest that symptom management and appropriate aspiration precautions are necessary in infants or children with presumed vagus or laryngeal nerve injury, and injury is likely only temporary.

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