Intralesional Bleomycin Sclerotherapy in the Treatment of Lymphovascular Malformations of the Head and Neck: A Case Series

Low-flow lymphovenous malformations (LVMs) are congenital vascular anomalies predominantly occurring in the head and neck region. This retrospective study evaluates the efficacy and safety of Intralesional Bleomycin Sclerotherapy in managing these lesions, with a focus on pediatric and young adult populations. A prospective analysis was conducted on 10 patients (aged 1–40 years) with head and neck LVMs treated between October 2019 and December 2024. All patients received three sessions of Intralesional Bleomycin (0.5 mg/kg per session) under endoscopic guidance. Treatment response was assessed using pre- and post-treatment measurements, MRI, and clinical evaluation. The Wilcoxon Signed-Rank Test was used for statistical analysis. The cohort showed a male predominance (70%) and pediatric skew (80% < 20 years). Lesions were most common on the tongue (40%). Bleomycin induced significant size reduction (median 82.8%, IQR 76.7–100%; p = 0.002), with 30% achieving complete resolution and 70% showing partial response (50–99% reduction). Complications were minimal (20% transient ulcers), and functional outcomes were favorable (median FSS score: 2–3). Intralesional bleomycin is a safe and highly effective treatment for LVMs, particularly in pediatric patients. The standardized 0.5 mg/kg protocol yielded consistent results across ages and lesion sites, with minimal morbidity. Larger studies are warranted to validate demographic trends and long-term durability.