Am J Surg. 2006 Sep;192(3):286-90.
Surgical treatment of jugular vein phlebectasia in children.
Jianhong L, Xuewu J, Tingze H.
Department of Pediatric Surgery, Second University Hospital of Shantou University Medical College, Dongxia Bei Rd., Shantou City, Guangdong Province, People's Republic of China, 515041. Lijh2925@163.com
Am J Surg. 2008 Nov;196(5):799.
Am J Surg. 2008 Mar;195(3):419-20.
BACKGROUND: Jugular vein phlebectasia (JVP) is a cervical mass that occurs relatively infrequently and usually presents in children as a soft cystic swelling in the neck during straining. It is liable to be misdiagnosed or managed inappropriately. This report elucidates the clinical presentation, diagnosis, treatment choices, and postoperative complications of JVP, and diagnostic methods and treatment choices are recommended.
METHODS: Fifty-one cases of JVP were reviewed (right vein in 38 patients, left in 7 patients, and bilateral in 6 patients). The internal jugular vein was involved the most frequently. The main complaint was a soft and compressible mass in the neck, becoming more prominent with the Valsalva maneuver. All of the children except 2 had an ultrasound or color Doppler flow imaging (CDFI) performed in combination with the Valsalva's breathing test. Surgical intervention was performed in 46 patients and the other 5 patients were followed-up conservatively for 2 to 15 years.
RESULTS: Ultrasound or CDFI showed local dilatation of unilateral or bilateral veins in all patients except 2, and confirmed the diagnosis in combination with the Valsalva's breathing test. Surgical intervention included ligation of the involved jugular vein in 32 patients, and longitudinal constriction suture venoplasty plus encapsulation with medical Dacron cloth or PTFE in 14 patients. All of the children who had surgery recovered uneventfully, except 3 patients undergoing ligation of the right internal jugular vein.
CONCLUSIONS: The Valsalva maneuver was most important for establishing the diagnosis. Ultrasound or CDFI, or in combination with the Valsalva's breathing test, was the diagnostic procedure of choice to confirm the diagnosis of JVP because of its clarity, safety, and low cost. Surgical intervention was recommended for cosmetic and psychologic purposes. Ligation or excision of the involved jugular vein was very safe, simple, and effective for most patients. However, in cases of lesions of the right and bilateral internal jugular veins, longitudinal constriction suture venoplasty plus encapsulation might be more preferable and safer, and should be recommended. Otherwise, treatment should be conservative (follow-up evaluation).
For jugular phlebectasia, for "cosmetic and psychologic" purposes, doctors are ligating children's jugulars. This was published in 2006. "Very safe, simple and effective" in the short term. But what happens to those kids when they turn 30.
It's no fault of the doctors for not knowing, but now that it's known, the jugular needs to be preserved as much as possible. I don't know what the alternative mentioned is ("longitudinal constriction suture venoplasty plus encapsulation") but if that preserves the jugular, then that is what I'd want my child to have.