Juan

For six-year-old Juan, life in southern Uruguay was typical. He played soccer, instructed in Tae Kwon Do, raced around on bicycles with his friends and attended kindergarten.

One mid-November day, Juan's parents noticed something they described as a mosquito's bite on their son's neck, just below his jaw line. Within three days, the finite mark enlarged to the size of a grapefruit.

"As a parent, this was alarming. The growth also made Juan physically uncomfortable and terribly self conscious," says Juan Pablo, the boy's father. "We knew Juan needed immediate medical attention."

Seeking Answers

Juan's parents sought treatment at the Montevideo Clinic, in the capital city of Uruguay. The diagnosis was complex; Juan was born with a rare condition of the lymphatic system — lymphangioma. It's a rare disorder. Fortunately, lymphangiomas are non-cancerous. Unfortunately, there aren't any quick-fix treatments — no special diets or drugs.

The treatment of choice is removal of the mass. And the surgery is complex because it involves lymph nodes; and depending on the location of the lesion, may also involve facial nerves and the muscles used for chewing and swallowing.

"Juan's growth was large and possibly involved muscles in his neck and face," says his father. "The doctors in Uruguay did not have experience with masses in this particular area and felt Mayo Clinic would have better results for a complete removal."

"Lymphangioma — or lymphatic malformations — can occur anywhere in the body, but more than 50 percent are in the head and neck region, like Juan's," says Eric J. Moore, M.D., an otolaryngologist and head and neck surgeon at Mayo Clinic in Rochester. Although lymphangiomas are rare, comprising only three cases in a thousand, Mayo Clinic has had excellent treatment results.

Juan's Treatment

Juan's father took time away from his business to accompany his son and wife, Ines Maria, to Minnesota. It was nearing Christmas, and Juan wanted to stay and enjoy the usual holiday festivities. Fortunately, doctors were able to arrange an appointment rather quickly and Christmas might have to wait.

The 22-hour flight was filled with apprehension and worry. "We wanted this unsightly mass to be gone. Medically and cosmetically, we knew challenges lay ahead," recalls Juan's father.

Initially, Juan saw Laura Orvidas, M.D., an otolaryngologist and head and neck surgeon at Mayo Clinic in Rochester, who has studied and written reports on pediatric lymphangiomas of the head and neck.

"These lesions are prone to sudden and extensive enlargement and can produce considerable cosmetic and functional impairment," says Dr. Orvidas. So although Juan's family thought the situation was quite bizarre, it was typical of a lymphatic malformation. "Given the size of Juan's lesion and his age, surgical treatment was the recommended option."

If lymphangiomas in the neck region grow too large, they can interfere with swallowing and breathing. In rare cases, the condition can be fatal. "Because Juan's condition involved only one site in the neck, it represented the best chance of complete removal with no recurrence," says Dr. Orivdas.

Dr. Orvidas involved Dr. Moore in Juan's care and surgery was scheduled in three days. "The operation resulted in complete removal of the lesion with no interference to his facial nerve or other vital structures," says Dr. Moore.

Back to Uruguay

Within a few days, Juan was discharged from the hospital, checked out his hotel room and anxiously waiting to board the plane for the return trip home to Uruguay, just in time for Christmas.

At the airport, Juan races around asking for "pesos," to buy gumballs. "We are so grateful for the prompt and effective treatment our son received," says Juan Pablo. "Thanks to Mayo Clinic, my son will begin first grade with no physical or emotional scars."

For Juan, his congenital lymphatic malformation will likely never recur. His family will remember Mayo Clinic with la esperanza, which means "with hope" in English.

Back at home, Juan is doing wonderfully. He is once again a typical six-year-old Uruguayan boy.