CPT® Code 38550

1. Indications

The excision of a cystic hygroma is indicated for the following conditions:

• Cystic Hygroma Presence The procedure is performed when a cystic hygroma, or cystic lymphangioma, is diagnosed, which may be present at birth or develop later in life.
• Symptomatic Cystic Hygroma Indications include cases where the cystic hygroma causes symptoms such as discomfort, pain, or functional impairment due to its size or location.
• Cosmetic Concerns The excision may also be indicated for cosmetic reasons, particularly if the cystic hygroma is located in a visible area, such as the neck or axilla, and affects the patient's appearance.

2. Procedure

The procedure for excising a cystic hygroma involves several detailed steps:

• Step 1: Incision The surgeon begins by making an incision through the skin and subcutaneous tissue overlying the cystic hygroma. This initial incision allows access to the cystic mass.
• Step 2: Exposure of the Cystic Mass If the cystic hygroma is located in the axilla, deeper tissues are carefully opened to expose the cystic mass. The surgeon performs meticulous dissection around nerves and blood vessels to avoid damage to these critical structures.
• Step 3: Dissection in the Neck For cystic hygromas situated in the neck, the platysma muscle is incised, and subplatysmal flaps are created. This step is crucial for accessing deeper tissues, which may require further dissection.
• Step 4: Preservation of Neurovascular Structures During the dissection, the surgeon carefully preserves the carotid sheath, which contains the carotid artery, internal jugular vein, and vagus nerve. This preservation is vital to prevent complications.
• Step 5: Complete Dissection The dissection continues around all involved blood vessels and nerves until the cystic sac is completely freed from the surrounding tissue, ensuring that the cystic mass can be removed without complications.
• Step 6: Excision of the Cystic Sac Once the cystic sac is adequately dissected, it is excised from the body. If multiple cystic sacs are present, each one is dissected and excised in a similar manner.

3. Post-Procedure

After the excision of a cystic hygroma, post-procedure care typically includes monitoring the surgical site for signs of infection, managing pain, and ensuring proper wound healing. Patients may be advised to keep the area clean and dry, and follow-up appointments are often scheduled to assess recovery and address any complications. The expected recovery time may vary depending on the extent of the procedure and the individual patient's health status. It is important for patients to adhere to their surgeon's post-operative instructions to facilitate optimal healing.