Pediatric Lymphangioma of the Tongue, From Diagnosis to Surgery: A Case Report

Introduction: Lymphangioma is a rare pediatric benign lesion caused by a congenital malformation of the lymphatic system. Most often (50%–70%) lymphatic malformations affect skin and subcutaneous tissue of the head and neck region, rarely the oral cavity. Intraoral lymphatic malformation occurs most commonly on the dorsum of the tongue, followed by the palate, buccal mucosa, gums, and lips. Lymphatic malformations are clinically and radiologically classified into three types, according to the cystic size: microcystic (< 1 cm), macrocystic (> 1 cm), and mixed. Differential diagnoses for lingual lymphatic malformation include other vascular malformations, neurofibromas, thyroglossal cysts, and congenital hypothyroidism. Treatment is usually multidisciplinary. Early diagnosis is essential to prevent functional complications such as difficulties in speech, mastication, swallowing, and, in severe cases, airway obstruction. Imaging techniques including ultrasound, MRI, and CT are fundamental to assessing the lesion′s extension and relationship with surrounding structures. Histopathological confirmation remains the gold standard for definitive diagnosis. Therapeutic approaches include surgical excision, sclerotherapy, laser therapy, and in selected cases, systemic pharmacological treatments. Complete surgical removal may be challenging due to the infiltrative nature of the lesion and proximity to vital anatomical structures. Recurrence is relatively common, especially in microcystic and mixed types. Prognosis is generally favorable when appropriate management is achieved, although long-term follow-up is required. Methods: A 4-year-old female patient presented for a clinical consultation visit due to a lesion on the dorsum of the tongue. The local objective clinical examination revealed a lesion of the dorsum of the tongue, raised, erythematous, and nonbleeding. The size was about 10–12 mm and was not painful on palpation. Topical miconazole therapy was recommended at first, suspecting a fungal superinfection. Head and neck MRI with and without contrast was prescribed for suspected vascular lesions, but the result was not conclusive. In the end, surgical excision was programmed, and histological analysis confirmed the lymphatic malformation. Results: This case shows the efficacy of surgical treatment in tongue lymphatic malformation. In fact, the surgical treatment successfully confirmed the nature of the lesion, alleviating patient discomfort and improving the patient′s quality of life. Postoperative healing was uneventful at 1-month follow-up. Conclusions: Recognition of lymphatic malformations in rare locations such as the oral cavity is essential to prevent misdiagnosis and ensure timely, appropriate management.