Comparison Between Treatment Outcomes of Pediatric Cystic Hygroma in Head Neck Region Using Different Sclerosing Agents

Open Access

Abstract

Background: Pediatric cystic hygroma, a congenital lymphatic malformation commonly affecting the head and neck, poses significant treatment challenges due to its proximity to vital structures. Sclerotherapy has emerged as a minimally invasive alternative to surgery, but comparative outcomes of different sclerosing agents remain limited. Aim of the study: To evaluate and compare the efficacy, safety, and recurrence rates of bleomycin, tetracycline, and sodium tetra-acetyl sulfate in the treatment of pediatric head and neck cystic hygroma. Methods & Materials: In this prospective, comparative study at Bangladesh Shishu Hospital & Institute (Aug 2023–Jan 2025), 60 treatment-naïve pediatric patients were randomly allocated into three equal groups to receive one of the three sclerosing agents. Sclerotherapy was administered every 2 months for three doses. Treatment response was assessed at 6 months as complete, partial, or no response using clinical examination and ultrasound. Recurrence and adverse events were recorded. Data were analyzed using IBM SPSS Statistics v26.0; categorical variables were compared with Chi-square/Fisher’s exact tests, and continuous variables with ANOVA/Kruskal–Walli’s test. Relative risk (RR) with 95% confidence intervals (CI) was calculated for recurrence. Result: Complete response rates were 45.0%, 55.0%, and 70.0% for bleomycin, tetracycline, and sodium tetra-acetyl sulfate, respectively. Overall response was highest with sodium tetra-acetyl sulfate (80%), followed by tetracycline (75%) and bleomycin (60%). Recurrence rates were 40%, 25%, and 15% respectively (p=0.04), with bleomycin showing significantly higher recurrence risk compared to sodium tetra-acetyl sulfate (RR=2.67; 95% CI:0.87–8.20; p=0.03). Adverse events were minor and comparable across groups. Conclusion: Sclerotherapy is an effective and safe first-line treatment for pediatric head and neck cystic hygroma. Sodium tetra-acetyl sulfate demonstrated superior efficacy and lower recurrence, suggesting it may be the preferred sclerosing agent in this population. SPSS-based analysis provided robust statistical validation of intergroup differences.