What is OK 432? How does it act? Which type of lymphangioma is more sensitive to it? How is lymphangioma managed surgically?
It is the new intralesional injection used to treat lymphangioma. It is named OK-432 (picinabil). The following are the advantages of OK-432:
It is an immuo-modulatory agent and a lyophilized incubation material derived from group A pyogenic streptococcal culture.
It induces an intense inflammatory reaction within the hygroma and leads to adhesion or increase permeability of the endothelial lining increasing the rate of drainage from the lesion. Thus obliterates the cystic spaces.
It also causes thrombosis with subsequent necrosis.
Dose: 4 does at 6-8 wk intervals.
86% successful outcome predominantly for macro-cystic cases.
It may be less effective in cavernous lymphangioma and lymphangioma with haemangiomatous elements.
P.S . more effective treatment in cystic type
Surgical excision remains the treatment of choice though challenging because cystic hygroma has an apparent disregard for an anatomical planes which makes total excision difficult.
Surgery can be helped by the injection of tissue blue into the lymphatic spaces.
Some surgeons thus prefers less radical surgical decompression using vacuum drains and/or marsupialization of the cysts(Thomson)
More radical approach should be made in gross cases without regard for the facial nerve (Mustarde) + (very extensive +- tracheostomy)
Since the gross involvement and stretching of the facial muscles renders their preservation pointless and usually impossible.
A series of planed resection and subsequent reconstruction may be needed complication: residual disease (50%) residual/ recurrence more in suprahyoid disease due to complete anatomy.
Impairment of speech swallowing and breathing(44%) cosmetic deformity (36%)