| Summary: | Objectives: Lymphatic malformations (LM) are uncommon expansile lesions that may lead to aesthetic or functional impairment requiring intervention. Although recurrence and treatment-related complications are often reported for a subset of patients with extensive cervical LM, primary excision with a selective neck dissection approach is safe and effective. Study design: Case series at a single academic tertiary care center. Methods: Retrospective chart review was performed of clinical presentation, radiographic characteristics, operative notes, and pathology reports of three patients with large cervical LM who underwent complete surgical excision between July 2012 and December 2017. Results: Two-thirds were female with a median age of 39 years (range 34–49 years) All patients had left-sided lesions ranging in size from 6 to 20 cm. Presenting symptoms included increasing neck discomfort and disfigurement. All patients had lesions that were mobile to palpation, macrocystic and well-circumscribed on preoperative imaging without invasion of the upper aerodigestive tract, and without cranial neuropathy. There were no postsurgical cranial nerve issues, complications, or recurrence at a median follow up of 14.7 months (range 10.0–74.9 months). Conclusion: Adult patients with mobile, primarily macrocystic, and well-circumscribed cervical LM with no preoperative cranial nerve deficits are excellent candidates for primary surgical excision, even in cases of exceptionally large multicompartment lesions. If patients are carefully selected, surgery offers the distinct advantage of definitive treatment with a single modality in a single stage and minimal post-treatment morbidity. Keywords: Cervical lymphatic malformation, Congenital malformation, Primary surgical excision, Selective neck dissection
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