Background <p>This study aims to investigate whether indocyanine green lymphography (ICGL) facilitates the effectiveness and accuracy of current management of lingual microcystic lymphatic malformation (mLM).</p> Methods <p>This retrospective included patients under 18 years old with mLM of the tongue staged I or IIA, who underwent ICGL-aided surgical resection and sclerotherapy (ICGL group) or only surgical resection and sclerotherapy (non-ICGL group) between January 2019 and June 2024. The peri- and postoperative parameters of safety and feasibility were compared between two groups.</p> Results <p>A total of 42 patients were included, 19 of whom received ICGL-guidance and the other 23 were in non-ICGL group. The comparison of baseline data between the two groups revealed no significant difference. Compared to the non-ICGL group, the ICGL group demonstrated superior efficacy (<i>P</i> = 0.017) and required fewer subsequent treatment sessions (<i>P</i> = 0.027), but had longer operative duration (<i>P</i> = 0.001). No significant differences were observed in terms of postoperative complications, length of hospital-stay, and follow-up period.</p> Conclusions <p>ICGL was associated with improved postoperative outcomes and less subsequent treatment. This technique may provide rational guidance with promising clinical prospects for management of mLM of the tongue.</p> Trail registration <p>This study was retrospectively registered on clinicaltrials.gov: NCT06755905, date of registration: January 20, 2025.</p>