Cystic Hygroma or Lymphangioma are a malformation of the lymphatic system and occurs as a result of sequestration or obstruction of lymphatic vessels. They are usually manifested in the paediatric age group and are rare in adults. We present a case of a giant cystic hygroma of the neck in a 75 year old male patient who was managed surgically. We described the clinical findings surgical technique and technical difficulty encountered in this case. Keyword :Cystic Hygroma, Lymphangioma in Adult,

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... fficult intubation. INTRODUTION: Cystic hygroma (lymphangioma) is often a benign congenital malformation of the lymphatic system that occurs as a result of sequestration or obstruction of lymphatic vessels. These lesions are usually discovered in infant or children younger than two years of age. Occurrence in adults is uncommon, and fewer than 100 cases of adult lymphangioma have been reported in the literature (1,2). The objectives of this case report are to present the clinical history and surgical findings , review of literature and the unique problems encountered in the surgical management of this particular patient CASE REPORT: HISTORY A 75 yr old south indian male, an agricultural labourer presented in our OPD with complaints of swellimg in the neck for a 2 year duration. It was slowly increasing in size snd posed a restriction to neck movements He had no complaints regarding his voice or deglutition.. He was particularly alarmed and concerned about the fact that following aspiration of the swelling a couple of weeks ago by a private practitioner the swelling had reappeared with increased vigour and attained its original size. He was not a diabetic and had no history of trauma or respiratory tract infection in the recent relevant past. Physical examination revealed a diffuse ,smooth, soft fluctuant non transilluminant swelling measuring 20 /18 cm which occupied the whole of the anterior neck pushing the right sternocleidomastoid muscle and carotid laterally. The swelling was predominantly present over the right side and encompassed the submandibular, carotid, muscular and posterior triangles on the right side. Indirect laryngeal examination revealed normal mobile vocal cords. On the left side it did not cross lateral to the sternomastoid muscle .the larynx and trachea were not palpable in the midline and were pushed far to the left and were palpable along the lateral border of he neck on the left. the left carotid was palpable in normal position and was not displaced. A presumptive diagnosis of a cystic hygroma was made and investigations were carried out.