Bleomycin Efficacy in Treatment of Head and Neck Lymphatic Malformations: Case Series of Patients Presenting to a Tertiary Children's Hospital in Iran From 2017 to 2021 Publisher



Mirashrafi F ; Karvanian S ; Rahaviezabadi S ; Mehdizadeh M ; Anari MR ; Sayarifard A
Source: Innovative Journal of Pediatrics Published:2026

Abstract

Background: Lymphatic malformations, including cystic hygromas, are benign vascular lesions primarily affecting children. They can cause cosmetic and functional impairments and, in severe cases, compress vital structures such as the airways. Surgical excision, the traditional treatment, often leads to complications, including incomplete removal, deformities, and recurrence. As an alternative, sclerotherapy using agents like bleomycin has gained popularity for its minimal invasiveness and effectiveness in reducing lesion size. Objectives: This study aimed to evaluate the efficacy of intralesional bleomycin sclerotherapy in reducing the size of lymphatic malformations in pediatric patients and to assess the treatment's safety and side effects. Methods: A case series of 40 pediatric patients with ultrasound sonography-diagnosed lymphatic malformations at a Children's Medical Center between 2017 and 2021 was evaluated. Patients received intralesional bleomycin injections and were monitored for changes in lesion size and side effects. Treatment response was categorized as excellent (> 90% reduction), good (> 50% reduction), or poor (< 50% reduction). Patients with poor response after five injections were considered for surgical intervention. Results: Of the 40 patients, 32.5% achieved an excellent response, 55% showed a good response, and 12.5% had a poor response. The average lesion size reduction was approximately 71%. Side effects included fever (20%), erythema (25%), and hyperpigmentation (12.5%), with no life-threatening complications reported. Only 7.5% of patients required surgery, and no recurrences were observed during follow-up. Conclusions: Intralesional bleomycin sclerotherapy is an effective and safe treatment for lymphatic malformations, providing significant lesion size reduction with minimal side effects. It offers a viable non-surgical alternative, reducing the need for invasive surgery and associated complications. © 2026 Brieflands. All rights reserved.