{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T02:06:02Z","timestamp":1785895562378,"version":"3.56.0"},"reference-count":27,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,6,3]],"date-time":"2022-06-03T00:00:00Z","timestamp":1654214400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Large (De Serres stage [IV\u2013V]) head and neck lymphatic malformations (HNLMs) often have multiple, high\u2010risk, invasive treatments (ITs) to address functional compromise. Logically reducing HNLM ITs should reduce treatment risk. We tested whether delaying HNLM ITs reduces total IT number.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials<\/jats:title><jats:p>Consecutive HNLM patients (<jats:italic>n<\/jats:italic>\u00a0=\u2009199) between 2010 and 2017, aged 0\u201318\u2009years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>ITs (surgery or sclerotherapy) were offered for persistent or dysfunction causing HNLMs. Treatment effectiveness categorized by IT number: optimal (0\u20131), acceptable (2\u20135), or suboptimal (&gt;5). Clinical data were summarized, and outcome associations tested (<jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup>). Relative risk (RR) with a Poisson working model tested whether HNLM observation or IT delay (&gt;6\u2009months post\u2010diagnosis) predicts treatment success (i.e., \u22641 IT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median age at HNLM diagnosis was 1.3\u2009months (interquartile range [IQR] 0\u201345\u2009m) with 107\/199(54%) male. HNLM were stage I\u2013III (174 [88%]), IV\u2013V (25 [13%]). Initial treatment was observation (70 [35%]), invasive (129 [65%]). Treatment outcomes were optimal (137 [69%]), acceptable (36 [18%]), and suboptimal (26 [13%]). Suboptimal outcome associations: EXIT procedure, stage IV\u2013V, oral location, and tracheotomy (<jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.001). Stage I\u2013III HNLMs were initially observed compared with stage I\u2013III having ITs within 6\u2009months of HNLM diagnosis, had a 82% lower relative treatment failure risk ([i.e., &gt;1 IT], RR\u00a0=\u00a00.09, 95% CI 0.02\u20130.36, <jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.001). Stage I\u2013III HNLMs with non\u2010delayed ITs had reduced treatment failure risk compared with IV\u2013V (RR\u00a0=\u00a00.47, 95% CI 0.33\u20130.66, <jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Observation and delayed IT in stage I\u2013III HNLM (\u201cGrade 1\u201d) is safe and reduces IT (i.e., \u22641 IT). Stage IV\u2013V HNLMs (\u201cGrade 2\u201d) with early IT have a greater risk of multiple ITs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 133:956\u2013962, 2023<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.30237","type":"journal-article","created":{"date-parts":[[2022,6,3]],"date-time":"2022-06-03T12:08:25Z","timestamp":1654258105000},"page":"956-962","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Delaying Invasive Treatment in Unilateral Head and Neck Lymphatic Malformation Improves Outcomes"],"prefix":"10.1002","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7174-7609","authenticated-orcid":false,"given":"Juliana","family":"Bonilla\u2010Velez","sequence":"first","affiliation":[{"name":"Division of Pediatric Otolaryngology\u2013Head and Neck Surgery Seattle Children's Hospital  Seattle Washington U.S.A."},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Washington School of Medicine  Seattle Washington U.S.A."},{"name":"Center for Clinical and Translational Research Seattle Children's Research Institute  Seattle Washington U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn B.","family":"Whitlock","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology\u2013Head and Neck Surgery Seattle Children's Hospital  Seattle Washington U.S.A."},{"name":"Center for Clinical and Translational Research Seattle Children's Research Institute  Seattle Washington U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila","family":"Ganti","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology\u2013Head and Neck Surgery Seattle Children's Hospital  Seattle Washington U.S.A."},{"name":"Center for Clinical and Translational Research Seattle Children's Research Institute  Seattle Washington U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giri M.","family":"Shivaram","sequence":"additional","affiliation":[{"name":"Center for Clinical and Translational Research Seattle Children's Research Institute  Seattle Washington U.S.A."},{"name":"Interventional Radiology, Department of Radiology Seattle Children's Hospital  Seattle Washington U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5308-527X","authenticated-orcid":false,"given":"Randall A.","family":"Bly","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology\u2013Head and Neck Surgery Seattle Children's Hospital  Seattle Washington U.S.A."},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Washington School of Medicine  Seattle Washington U.S.A."},{"name":"Center for Clinical and Translational Research Seattle Children's Research Institute  Seattle Washington U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2728-3576","authenticated-orcid":false,"given":"John P.","family":"Dahl","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology\u2013Head and Neck Surgery Seattle Children's Hospital  Seattle Washington U.S.A."},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Washington School of Medicine  Seattle Washington U.S.A."},{"name":"Center for Clinical and Translational Research Seattle Children's Research Institute  Seattle Washington U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott C.","family":"Manning","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology\u2013Head and Neck Surgery Seattle Children's Hospital  Seattle Washington U.S.A."},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Washington School of Medicine  Seattle Washington 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