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Paladini I, Schirò S, Ledda RE, Leo L, Milanese G, Epifani E, Andreone A, Capurri G, Fantoni M, Gemignani A, Gritti A, Sesenna E, Menozzi R. Percutaneous injection of sclerosant agents as an effective treatment for cystic malformations of the head and neck. Oral Maxillofac Surg 2024; 28:809-818. [PMID: 38261079 DOI: 10.1007/s10006-024-01210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/14/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE To evaluate the clinical and aesthetic outcome of percutaneous injection of sclerosant agents to treat head and neck cystic malformations (HNCM) and to assess their recurrence rate based on histology and site. METHODS Fifty-four subjects (mean age 46 years) with HNCM treated by percutaneous injection of sclerosant agents between January and December 2017 were included. Imaging and clinical data before and after the procedure were collected. Quality of Life Index, Pain Visual Analogue Scale, and Aesthetic Scale scores were measured to assess clinical and aesthetic outcomes. A size reduction of ≥ 70% assessed through the visual scale was considered significant. RESULTS Of the 54 HNCM, there were 26 (48%) lymphatic malformations (LM), 13 (24%) salivary epithelial duct cysts of the parotid gland, 12 (22%) salivary mucoceles, and 3 (5%) branchial cysts. A significant size reduction and a satisfactory clinical-aesthetic outcome were observed in all types of LM. The number of reinterventions was significantly associated with the number of lesions (p < 0.001). The lowest number of interventions was observed in macrocystic lymphatic malformations (average of 1.2 interventions). All salivary epithelial duct cysts showed a significant reduction in size, a satisfactory clinical-aesthetic outcome, and an average of 1.16 interventions per patient. Mucoceles had a worse response, with only 3/14 patients showing a satisfactory and long-lasting clinical outcome (average of 1.16 interventions). Treatment of branchial cysts showed the worst outcome with a limited clinical response (3/3). CONCLUSION Percutaneous injection of sclerosant agents may be considered as a first-line treatment for LM and salivary epithelial duct cysts.
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Affiliation(s)
- Ilaria Paladini
- Unit of Interventional Radiology, Diagnostic Department, Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Silvia Schirò
- Department of Medicine and Surgery (DiMec), University of Parma, Via gramsci 14 (43126), Parma, Italy.
| | - Roberta Eufrasia Ledda
- Department of Medicine and Surgery (DiMec), University of Parma, Via gramsci 14 (43126), Parma, Italy
| | - Ludovica Leo
- Department of Medicine and Surgery (DiMec), University of Parma, Via gramsci 14 (43126), Parma, Italy
| | - Gianluca Milanese
- Unit of "Scienze Radiologiche", Department of Medicine and Surgery (DiMeC), University Hospital of Parma, Parma, Italy
| | - Enrico Epifani
- Unit of Interventional Radiology, Diagnostic Department, Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Andrea Andreone
- Unit of Interventional Radiology, Diagnostic Department, Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Giulia Capurri
- Unit of Interventional Radiology, Diagnostic Department, Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Matteo Fantoni
- Neuroradiology Unit, Diagnostic Department, University Hospital of Parma, Via Volturno 39, 43125, Parma, Italy
| | - Andrea Gemignani
- Department of Medicine and Surgery (DiMec), University of Parma, Via gramsci 14 (43126), Parma, Italy
| | - Alessandro Gritti
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma,, Parma, Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery Division, Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - Roberto Menozzi
- Interventional Neuroradiology Unit, Diagnostic Department, University Hospital of Parma, Via Volturno 39, 43125, Parma, Italy
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Narang E, Jain N, Kaur J, Roy S, Singh J. Conservative treatment of Head and Neck hemangiomas using Intralesional Bleomycin. Indian J Otolaryngol Head Neck Surg 2023; 75:236-240. [PMID: 37275108 PMCID: PMC10235280 DOI: 10.1007/s12070-022-03133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/19/2022] [Indexed: 10/14/2022] Open
Abstract
Background Hemangiomas are vascular tumours and commonly occur in head and neck region. Complete treatment of these vascular swellings are often challenging. As surgical excision carries high risk of complications and poor cosmetic outcome, treatment is shifted more towards non-surgical modalities like steroid therapy, radiotherapy, chemotherapy and sclerotherapy. Objective To study the efficacy of intralesional Bleomycin sclerotherapy for head and neck hemangiomas. Method Seventeen patients ( 9 males and 8 females) with head and neck hemangiomas were treated with sclerotherapy using intralesional bleomycin injection ( 0.1-0.5 mg/kg/ dose) in a medical college of India. Details of the patients were recorded along with serial photographs of lesion. Post injection outcomes in form of reduction of lesion size, patient satisfaction and complications were also recorded. Results 11 patients were completely cured, 3 had more than 50% reduction in size, one patient showed minimal reduction and two had no response. One patient had superficial ulceration, one case of slough and fever was reported. None of the patients developed severe toxic side effects and pulmonary fibrosis with follow up of 18 months. Conclusions Bleomycin injection is safe, easy and well tolerated method for treatment of head and neck hemangiomas. We recommend surgery only if there is no response to other conservative treatment modalities.
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Affiliation(s)
- Ekta Narang
- Department of Otorhinolaryngology, Chacha Nehru Bal Chikitsalaya Geeta Colony, Delhi, India
| | - Neha Jain
- Department of Otorhinolaryngology, Chacha Nehru Bal Chikitsalaya Geeta Colony, Delhi, India
| | - Jaswinder Kaur
- Department of Otorhinolaryngology, RML Hospital, Delhi, India
| | - Suparna Roy
- Department of Otorhinolaryngology, Chacha Nehru Bal Chikitsalaya Geeta Colony, Delhi, India
| | - Jyoti Singh
- Department of Otorhinolaryngology, Chacha Nehru Bal Chikitsalaya Geeta Colony, Delhi, India
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Alexander L, Chacko H. A Curious Case of Ear Necrosis Salvaged by a Composite Temporalis Flap: Conchal Cartilage Graft Reconstruction. Cureus 2021; 13:e15653. [PMID: 34277246 PMCID: PMC8280958 DOI: 10.7759/cureus.15653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Abstract
Hemangiomas are commonly encountered benign vascular tumors in clinical practice. They are easily diagnosed clinically, but it is essential to know atypical and rare varieties of these tumors to avoid confusing them with vascular malformations. The traditional approach in managing hemangiomas has been a “wait and watch” policy as most of these lesions undergo spontaneous regression with time. There are multiple treatment modalities in managing these lesions, but with specific indications for each of them. We report a case of Nicolau syndrome following injection sclerotherapy for a residual ear hemangioma, which lead to necrosis and total loss of skin and cartilage. However, the full-thickness defect in the ear was restored with a composite temporalis fascial flap, conchal cartilage graft, and split skin graft reconstruction. A detailed literature review of the presentation and management of this vascular tumor is discussed with a special emphasis on avoiding complications and maximizing patient outcomes.
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Affiliation(s)
- Leon Alexander
- Plastic & Reconstructive Surgery, Sheikh Khalifa Medical City, Abu Dhabi, ARE
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Tiwari P, Kumar R, Pandey V, Kar A, Tiwary N, Sharma S. A clinicopathological study to assess the role of intralesional sclerotherapy following propranolol treatment in infantile hemangioma. J Cutan Aesthet Surg 2021; 14:409-415. [PMID: 35283595 PMCID: PMC8906266 DOI: 10.4103/jcas.jcas_103_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Helal AA, Daboos MA. Five years’ experience of combined intralesional therapy in infantile hemangioma. ANNALS OF PEDIATRIC SURGERY 2019. [DOI: 10.1186/s43159-019-0008-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background
Infantile hemangiomas (IHs) are common vascular tumors. Although it involutes spontaneously, outcomes are unpredictable. Intralesional therapy is one of its treatment modality. We present our experience with combined intralesional therapy for IHs over a 5-year duration. A total of 427 patients were treated and followed at Al-Azhar University Hospitals during the study period of 5 years. All patients were treated by intralesional therapy in the form of combined injection of triamcinolone and bleomycin. All patients were followed for the response. Response to the treatment was graded as marked, partial, and poor improvement.
Results
IHs were noticed within the first month of life in 90.2% of patients. The commonest site of involvement was head and neck in 90% of patients. The commonest clinical presentation was swelling with discoloration. Mean age was 7.43 ± 6.04 months and mean IHs size was 15.54 ± 11.13 cm2. The response to the treatment was highest for patients below 1 year of age. The reported complications were ulceration, scarring, and subcutaneous atrophy in some cases.
Conclusion
Combined intralesional therapy in IHs showed good efficacy in most patients. It is a reliable and safe treatment modality with clear curative effects and minimal complications. If IHs treatment is indicated, combined intralesional therapy should be considered as an alternative effective treatment modality.
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Liu F, Xiao Y, Wang J. Therapeutic efficacy of intralesional bleomycin injection for laryngopharyngeal haemangioma in adults. Acta Otolaryngol 2019; 139:1117-1121. [PMID: 31556768 DOI: 10.1080/00016489.2019.1667528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Head and neck haemangiomas in the pharynx and larynx are rare, and the injection of bleomycin is currently one of the effective treatments. However, data on the therapeutic efficacy of this treatment are scarce.Objectives: To evaluate the clinical efficacy of bleomycin injection in the treatment of laryngopharyngeal haemangioma in adults and determine factors affecting efficacy.Materials and Methods: The clinical data of 42 adult patients with laryngopharyngeal haemangioma treated by intralesional bleomycin injection were retrospectively analysed to evaluate the clinical efficacy. Two groups (haemangioma reduction <50% and haemangioma reduction ≥50%) were compared to analyse factors affecting efficacy.Results: Seventy-five injections were administered to 42 patients: 34 (34/42 81%) patients with a haemangioma reduction ≥50% and 8 (8/42 19%) with a haemangioma reduction <50%. There was no difference in age, sex, haemangioma shape or number of operations between the two groups, but there was a significant difference in the base area of the haemangioma.Conclusions and Significance: Intralesional bleomycin injection is effective for the treatment of laryngopharyngeal haemangioma in adults. The base area of the haemangioma affects the therapeutic efficacy.
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Affiliation(s)
- Feifei Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yang Xiao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jun Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Düzenli Kar Y, Özdemir ZC, Acu B, Bör Ö. Infantile hemangioma: Efficacy of low-dose propranolol and of intralesional bleomycin injection for propranolol non-response. Pediatr Int 2019; 61:459-464. [PMID: 30861274 DOI: 10.1111/ped.13830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/26/2019] [Accepted: 03/07/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infantile hemangioma (IH) is the most common form of benign childhood vascular tumor. Most resolve spontaneously, but treatment is recommended in patients who develop complication. Propranolol is recommended as the first-line therapy, while the treatment in the case of non-response to first-line therapy depends on the clinical experiences of each center. The aim of this study was to investigate the efficacy of low-dose propranolol in the treatment of IH, and the outcomes of percutaneous intralesional bleomycin injection (IBI) in patients unresponsive to propranolol. METHODS Medical records of 104 children diagnosed with IH between June 2014 and June 2017 were reviewed retrospectively. RESULTS Median patient age was 6 months (range, 3-12 months). Forty-five patients (43.3%) received therapy: 18 (40%) for cosmetic problems and 27 (60%) for lesion-related complications. The most common complications were hemorrhage (15.6%) and impairment in visual function (15.6%). All of the patients received propranolol 1 mg/kg/day as the first-line therapy. Response to treatment was excellent in 35 patients, good in four and poor in one, while five patients did not respond to therapy. The five unresponsive patients received percutaneous IBI at 0.3-0.5 mg/kg/dose as second-line therapy. The response to treatment was excellent in four patients, good in one. CONCLUSIONS The majority of IH resolved spontaneously. In the patients who required treatment, low-dose propranolol was successful in most, and IBI was effective and safe in the remaining five patients who did not respond to propranolol.
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Affiliation(s)
- Yeter Düzenli Kar
- Division of Pediatric Hematology and Oncology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Zeynep Canan Özdemir
- Division of Pediatric Hematology and Oncology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Berat Acu
- Division of Radiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Özcan Bör
- Division of Pediatric Hematology and Oncology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
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Xu S, Yu Y, ElHakim H, Cui X, Yang H. The Therapeutic Effect of the Combination of Intratumor Injection of Bleomycin and Electroresection/Electrocautery on the Hemangiomas in Hypopharynx and Larynx Through Suspension Laryngoscopy. Ann Otol Rhinol Laryngol 2019; 128:575-580. [PMID: 30781970 DOI: 10.1177/0003489419831715] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The treatment of hemangiomas in the hypopharynx and larynx can be challenging and stressful because of the high tumor recurrence rate. The objective of this study was to investigate the therapeutic effect of the combination of intratumor injection of bleomycin and electroresection/electrocautery on the hemangiomas in the hypopharynx and larynx through suspension laryngoscopy. METHODS With patients under general anesthesia, the hemangiomas were fully exposed through suspension laryngoscopy. After intratumor injection of bleomycin, in some patients, the hemangiomas were completely resected along the bottom of the tumor pedicle by polypus-forceps electroscalpel; for other patients, the hemangiomas were pinched and held, and then the whole-tumor tissues were cauterized and coagulated by the electroscalpel. Prior to commencing the study, all participants signed informed consents, and all procedures were approved by the hospital ethical committee. RESULTS There was almost no bleeding during the operations, no postoperative dyspnea, and no hemorrhage. The patients were followed up for 3 years; the 3-year cure rate was 97%. CONCLUSION The hemangioma in the hypopharynx and larynx can be cured by a single-session treatment, using the combination of intratumor injection of bleomycin and electroresection/electrocautery through suspension laryngoscopy. Our method is reliable, affordable, and effective, and it could be widely applied in other hospitals.
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Affiliation(s)
- Shengqun Xu
- 1 The Sleep Medicine Center, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
| | - Yongqiang Yu
- 2 Department of Otolaryngology Head Neck Surgery, the Affiliated Mindong Hospital of Fujian Medical University, Mindong Hospital, Ningde, China.,3 Department of Speech Pathology and Audiology (Communication Sciences and Disorders), Faculty of Rehabilitation Medicine, University of Alberta, Alberta, AB, Canada
| | - Hamdy ElHakim
- 4 Department of Otolaryngology Head Neck Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Xiangguo Cui
- 1 The Sleep Medicine Center, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
| | - Huaian Yang
- 1 The Sleep Medicine Center, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
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Pandey V, Tiwari P, Sharma SP, Kumar R, Singh OP. Role of intralesional bleomycin and intralesional triamcinolone therapy in residual haemangioma following propranolol. Int J Oral Maxillofac Surg 2018; 47:908-912. [PMID: 29665992 DOI: 10.1016/j.ijom.2018.03.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/17/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Abstract
With the emergence of propranolol as the first choice of treatment for problematic infantile haemangioma at many centres, the number of patients with a partial or non-response to propranolol has also been growing. This study investigated the role of intralesional bleomycin and triamcinolone in patients with residual disease following propranolol therapy for infantile haemangioma. Sixty-seven patients with residual haemangioma were assigned randomly to receive either intralesional bleomycin (group A, n=36) or intralesional triamcinolone (group B, n=31). The response to treatment and adverse effects were assessed in both groups. All patients received at least four doses and a maximum of six doses of the assigned drug. In group A (mean follow-up 9.38months), 47.2% had an excellent response and 44.4% a good response. In group B (mean follow-up 7.42months), 25.8% had an excellent response and 48.4% a good response. There was no difference in overall response between the groups (P=0.074). Among patients who were initially non-responders to propranolol, bleomycin showed a better response than triamcinolone (P=0.037). This may be due to an overlap in the mechanism of action of propranolol and triamcinolone. Thus, intralesional bleomycin should be preferred in patients with no initial response to propranolol therapy, while bleomycin or triamcinolone can be used in patients with a partial response to propranolol therapy, as they have equal efficacy.
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Affiliation(s)
- V Pandey
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India
| | - P Tiwari
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
| | - S P Sharma
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India
| | - R Kumar
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India
| | - O P Singh
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University Varanasi, UP, India
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Raphael MF, Breur JMPJ, Vlasveld FAE, Elbert NJ, Liem YTB, Kon M, Breugem CC, Pasmans SGMA. Treatment of infantile hemangiomas: therapeutic options in regard to side effects and adverse events – a review of the literature. Expert Opin Drug Saf 2016; 15:199-214. [DOI: 10.1517/14740338.2016.1130125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Martine F. Raphael
- Department of Pediatric Dermatology and Allergology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes M. P. J. Breur
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Florine A. E. Vlasveld
- Department of Pediatric Dermatology and Allergology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niels J. Elbert
- Department of Pediatric Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Yves T. B. Liem
- Department of Clinical Pharmacy, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Moshe Kon
- Department of Pediatric Plastic Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Corstiaan C. Breugem
- Department of Pediatric Plastic Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Suzanne G. M. A. Pasmans
- Department of Pediatric Dermatology and Allergology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatric Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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Zhao XP, Huang ZQ, Chen WL, Wang YY, Lin ZY. Percutaneous sclerotherapy of arteriovenous malformations of the face using fibrin glue combined with OK-432 and bleomycin after embolisation. Br J Oral Maxillofac Surg 2015; 54:187-91. [PMID: 26705860 DOI: 10.1016/j.bjoms.2015.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 11/18/2015] [Indexed: 11/15/2022]
Abstract
Congenital arteriovenous malformations (AVM) in the maxillofacial region are rare, but potentially life-threatening, vascular lesions. Here we review our experience of 13 patients with AVM of the facial soft tissues who were treated using percutaneous sclerotherapy with fibrin glue combined with OK-432 and bleomycin after embolisation. The mean (range) follow-up was 27 (14-58) months. Three of the lesions were completely controlled, eight were nearly completely controlled, and the other two were partly controlled. Our experience is that percutaneous sclerotherapy of arteriovenous malformations of the face using fibrin glue combined with OK-432 and bleomycin after embolisation is safe and effective.
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Affiliation(s)
| | | | - Wei-liang Chen
- Professor and Director, Department of Oral and Maxillofacial Surgery, Sun Yat-sen, Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China.
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Galba J, Veizerová L, Piešťanský J, Mego M, Novotný L, Dokupilová S, Maráková K, Havránek E, Mikuš P. HPLC-QTOF-MS Method for Identification and Determination of Bleomycin A2 and B2 Fractions. J LIQ CHROMATOGR R T 2014. [DOI: 10.1080/10826076.2014.908783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jaroslav Galba
- a Department of Pharmaceutical Analysis and Nuclear Pharmacy, Faculty of Pharmacy , Comenius University in Bratislava , Bratislava , Slovak Republic
- b Faculty of Pharmacy, Toxicological and Antidoping Center , Comenius University in Bratislava , Bratislava , Slovak Republic
| | - Lucia Veizerová
- a Department of Pharmaceutical Analysis and Nuclear Pharmacy, Faculty of Pharmacy , Comenius University in Bratislava , Bratislava , Slovak Republic
- b Faculty of Pharmacy, Toxicological and Antidoping Center , Comenius University in Bratislava , Bratislava , Slovak Republic
| | - Juraj Piešťanský
- a Department of Pharmaceutical Analysis and Nuclear Pharmacy, Faculty of Pharmacy , Comenius University in Bratislava , Bratislava , Slovak Republic
- b Faculty of Pharmacy, Toxicological and Antidoping Center , Comenius University in Bratislava , Bratislava , Slovak Republic
| | - Michal Mego
- c Translational Research Unit, National Cancer Institute , Comenius University , Bratislava , Slovak Republic
| | | | - Svetlana Dokupilová
- a Department of Pharmaceutical Analysis and Nuclear Pharmacy, Faculty of Pharmacy , Comenius University in Bratislava , Bratislava , Slovak Republic
- b Faculty of Pharmacy, Toxicological and Antidoping Center , Comenius University in Bratislava , Bratislava , Slovak Republic
| | - Katarína Maráková
- a Department of Pharmaceutical Analysis and Nuclear Pharmacy, Faculty of Pharmacy , Comenius University in Bratislava , Bratislava , Slovak Republic
- b Faculty of Pharmacy, Toxicological and Antidoping Center , Comenius University in Bratislava , Bratislava , Slovak Republic
| | - Emil Havránek
- a Department of Pharmaceutical Analysis and Nuclear Pharmacy, Faculty of Pharmacy , Comenius University in Bratislava , Bratislava , Slovak Republic
- b Faculty of Pharmacy, Toxicological and Antidoping Center , Comenius University in Bratislava , Bratislava , Slovak Republic
| | - Peter Mikuš
- a Department of Pharmaceutical Analysis and Nuclear Pharmacy, Faculty of Pharmacy , Comenius University in Bratislava , Bratislava , Slovak Republic
- b Faculty of Pharmacy, Toxicological and Antidoping Center , Comenius University in Bratislava , Bratislava , Slovak Republic
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Inhibition of hemangioma development in a syngeneic mouse model correlates with bcl-2 suppression and the inhibition of Akt kinase activity. Angiogenesis 2011; 15:131-9. [DOI: 10.1007/s10456-011-9248-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 12/17/2011] [Indexed: 10/14/2022]
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Intralesional bleomycin injection treatment for vascular birthmarks: a 5-year experience at a single United Kingdom unit. Plast Reconstr Surg 2011; 127:2031-2044. [PMID: 21532430 DOI: 10.1097/prs.0b013e31820e923c] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The authors present their experience using an established chemotherapeutic agent as a scarless treatment for vascular birthmarks. One hundred sixty-four of more than 600 patients seen in the authors' center received intralesional bleomycin injection over 5 years. METHODS Patient demographics, clinical response, treatment, and complication details were recorded prospectively. Respiratory surveillance was provided by adult and pediatric pulmonologists. Eighty-one venous malformations, 39 hemangiomas, 26 lymphatic malformations, 10 mixed malformations, two arteriovenous malformations, two cystic hygromas, two capillary malformations, and two angiokeratomas underwent intralesional bleomycin injection. RESULTS The authors observed that 45.7 percent of patients completed treatment in a mean of 3.8 sessions and mean duration of 107 days. Complete resolution occurred in 56.0 percent, with a 93.3 percent overall response rate, and 82.7 percent of lesions demonstrated complete response or significant improvement. Three patients developed transient skin hyperpigmentation. One patient each developed skin ulceration, blistering, infection, swelling, headache, bruising, and rash. One patient required intubation following treatment of a panfacial and thoracic lymphatic malformation. A full recovery ensued. No patients developed pulmonary fibrosis. One venous malformation recurred. CONCLUSIONS The authors' single-site multidisciplinary team has successfully treated complex and recurrent vascular anomalies with acceptable complication and recurrence profiles. These findings represent the authors' experience and provide a reference for the management of these challenging lesions.
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Zheng JW, Yang XJ, Wang YA, He Y, Ye WM, Zhang ZY. Intralesional injection of Pingyangmycin for vascular malformations in oral and maxillofacial regions: an evaluation of 297 consecutive patients. Oral Oncol 2009; 45:872-6. [PMID: 19628423 DOI: 10.1016/j.oraloncology.2009.02.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 02/26/2009] [Accepted: 02/26/2009] [Indexed: 10/20/2022]
Abstract
The purpose of the study was to investigate the indications and treatment results of intralesional injection of Pingyangmycin for vascular malformations in oral and maxillofacial regions. Between June 2002 and July 2007, 297 patients with oral and maxillofacial vascular malformations (except venular malformation and arteriovenous malformation) were treated with percutaneous injection of Pingyangmycin in our department. There were 159 males and 138 females aged from 8 months to 72 years (mean age 20.6 years). The types of the disease included 98 lymphatic malformations (66 microcystic and 32 macrocystic malformations), 179 venous malformations, and 20 mixed lymphatic-venular or venous malformations. The lesions were located in the oral and maxillofacial and head and neck regions, and measured 0.8 cm x 1.0 cm -12.4 cm x 10.5 cm in size. Two hundred and forty-nine patients underwent intralesional injection of Pingyangmycin alone, 30 patients had laser therapy, and 18 patients underwent surgical excision as well. The number of injection sessions was 1-5, with an average of 3.5 times. Pingyangmycin, dexamethasone, and lidocaine were mixed for injection at concentrations of 1.0mg of Pingyangmycin per milliliter for microcystic lymphatic malformation and 2.0mg of Pingyangmycin per milliliter for venous malformation and macrocystic lymphatic malformation. The patients were followed up for 1-6 years after treatment. The results were evaluated based on B-type ultrasound examinations before and after treatment. The clinical cure rate of venous malformation, macrocystic lymphatic malformation, microcystic lymphatic malformation and mixed malformation was 74.86%, 84.38%, 38.88%, and 60.0%. Five patients had fever. No ulceration, necrosis, or anaphylactic reaction was found. Intralesional injection of Pingyangmycin at an adequate concentration can be used as the therapy of choice for small and medium-sized venous malformations, macrocystic lymphatic malformations, microcystic lymphatic malformations, and mixed malformations. The advantages included a high cure rate, safety and reliability, short course, easy manipulation, and fewer side effects with satisfactory recovery of appearance and function.
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Affiliation(s)
- Jia Wei Zheng
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Chen WL, Ye JT, Xu LF, Huang ZQ, Zhang DM. A multidisciplinary approach to treating maxillofacial arteriovenous malformations in children. ACTA ACUST UNITED AC 2009; 108:41-7. [PMID: 19464212 DOI: 10.1016/j.tripleo.2009.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 02/09/2009] [Accepted: 03/03/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Congenital arteriovenous malformations (AVMs) in the maxillofacial region are rare, potentially life-threatening, vascular lesions. This study reviewed our experience with a multidisciplinary approach to treating maxillofacial AVMs in children. STUDY DESIGN Thirteen patients (10 boys and 3 girls) with AVMs involving the facial soft tissues or jaws were treated using a multidisciplinary approach that included: 1) superselective intra-arterial embolization (SIAE); 2) bone wax packing (BWP) of the bone cavity and curettage; and 3) compartmentalization and sclerotherapy. RESULTS The mean follow-up was 13.5 months, with a range of 6-22 months. The following outcomes were obtained: 9 lesions (69.2%) were completely involuted, 3 lesions (23.1%) were mostly involuted, and 1 lesion (7.7%) was partially involuted. The rates of completely and mostly involuted AVMs involving the jaws treated using SIAE, BWP, and curettage were 80% and 20%, respectively. The rates of completely, mostly, and partially involuted AVMs involving soft tissues treated by compartmentalization and sclerotherapy were 60%, 30%, and 10%, respectively. CONCLUSION SIAE was reliable for controlling bleeding and as adjunctive treatment for maxillofacial AVMs in children. SIAE followed by BWP of the bone cavity and curettage was a simple, safe, and effective method for treating AVMs of the jaws; SIAE followed by compartmentalization and the injection of OK-432 and pingyangmycin was a reliable alternative treatment for AVMs of the soft tissues in the maxillofacial region.
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Affiliation(s)
- Wei-liang Chen
- Department of Oral and Maxillofacial Surgery, Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Zheng JW, Zhou Q, Yang XJ, He Y, Wang YA, Ye WM, Zhu HG, Zhang ZY. Intralesional injection of Pingyangmycin may be an effective treatment for epulis. Med Hypotheses 2009; 72:453-4. [DOI: 10.1016/j.mehy.2008.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 10/03/2008] [Accepted: 10/10/2008] [Indexed: 12/01/2022]
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A comparative study on the anti-angiogenic effects of DNA-damaging and cytoskeletal-disrupting agents. Angiogenesis 2009; 12:81-90. [PMID: 19214765 DOI: 10.1007/s10456-009-9134-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 01/26/2009] [Indexed: 10/21/2022]
Abstract
The discovery of molecules with anti-angiogenic properties has led to promising new strategies for the treatment of diseases characterized by excessive new vessel growth, such as cancer and haemangioma. We have assessed the effects of DNA-damaging and cytoskeletal-disrupting agents in vitro on several endothelial cell functions. We report that bleomycin, mitomycin C and cytoskeletal-disrupting drugs (2-methoxyestradiol, taxol, vincristine, vinblastine, colchicine, nocodazole, and cytochalasin D) exhibit anti-angiogenic activities of varying potency. Bleomycin and the various cytoskeletal-disrupting drugs inhibited endothelial cell migration, while mitomycin C had a marginal effect. Both DNA-damaging and cytoskeletal-disrupting drugs decreased endothelial cell growth in a dose-dependent manner, and this was accompanied by the induction of apoptosis. The growth inhibitory and apoptotic effects of cytoskeletal-disrupting drugs were the most pronounced. We also show that both classes of drugs inhibited capillary-like tube formation in an assay of in vitro angiogenesis, with cytoskeletal-disrupting agents inhibiting in vitro angiogenesis with greater potency. A targeted approach incorporating several compounds with different mechanisms of action may be useful for the treatment of angiogenesis-dependent diseases such as hemangiomas of infancy.
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Chen WL, Yang ZH, Bai ZB, Wang YY, Huang ZQ, Wang YJ. A pilot study on combination compartmentalisation and sclerotherapy for the treatment of massive venous malformations of the face and neck. J Plast Reconstr Aesthet Surg 2008; 61:1486-92. [DOI: 10.1016/j.bjps.2007.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2006] [Revised: 01/28/2007] [Accepted: 10/02/2007] [Indexed: 10/22/2022]
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Saitta P, Krishnamurthy K, Brown LH. Bleomycin in dermatology: a review of intralesional applications. Dermatol Surg 2008; 34:1299-313. [PMID: 18616538 DOI: 10.1111/j.1524-4725.2008.34281.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intralesional bleomycin has been favorably used off-label to treat various skin conditions. These include warts, hemangiomas, vascular malformations, telangiectasias, several types of cutaneous malignancies, condyloma acuminata, and the lesions of leishmaniasis cutis. Currently, there is a limited amount of evidence from randomized placebo-controlled trials comparing intralesional bleomycin with other local treatments for these disorders. In this article, we review the pharmacodynamics, mechanism of action, safety profile, and clinical applications of intralesional bleomycin. Dosages, techniques for administration, and efficacy of intralesional bleomycin for each aforementioned clinical entity are also provided. Given its ease and safety in administration, efficacy, and availability, off-label use of intralesional bleomycin can be considered another primary and/or adjunctive therapy for various common cutaneous conditions by practitioners in dermatology today.
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Affiliation(s)
- Peter Saitta
- School of Osteopathic Medicine, University of Medicine and Dentistry of New Jersey, Stratford, New Jersey, USA
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Affiliation(s)
- Michael J Sundine
- Aesthetic & Plastic Surgery Institute, University of California-Irvine, Orange, California 92868-3298, USA
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Omidvari S, Nezakatgoo N, Ahmadloo N, Mohammadianpanah M, Mosalaei A. Role of Intralesional Bleomycin in the Treatment of Complicated Hemangiomas: Prospective Clinical Study. Dermatol Surg 2006; 31:499-501. [PMID: 15962730 DOI: 10.1111/j.1524-4725.2005.31150] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hemangioma is the most common tumor of infancy. Although it has a basically benign nature and usually spontaneously regresses, a small percentage (5%) have complications that need treatment. Many different therapeutic modalities can be used in this tumor. OBJECTIVE To investigate the effect of a new method of treatment (intralesional bleomycin injection) in complicated hemangiomas. MATERIALS AND METHODS In the Department of Radiation Oncology at Nemazee Hospital in Shiraz, Iran, from April 1992 to October 1998, 32 patients with complicated hemangioma were treated with four to six courses of direct injection of bleomycin into the lesion. RESULTS After a minimum follow-up of 6 years, there was 70 to 100% regression in 18 patients, 50 to 70% in 7 cases, and less than 50% reduction in 7 patients. CONCLUSION Intralesional injection of bleomycin is an easy, safe, and effective therapeutic modality in complicated cutaneous hemangiomas.
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Affiliation(s)
- Shapour Omidvari
- Department of Radiation Oncology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Pienaar C, Graham R, Geldenhuys S, Hudson DA. Intralesional bleomycin for the treatment of hemangiomas. Plast Reconstr Surg 2006; 117:221-6. [PMID: 16404271 DOI: 10.1097/01.prs.0000194906.61805.b0] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hemangiomas, although often small at birth, enter a proliferative phase in which growth may be rapid and unpredictable. Furthermore, involution often takes many years, with attendant psychological sequelae to the child. This is aggravated by the fact that most hemangiomas affect the head and neck and are visible and difficult to conceal. METHODS Thirty children (five boys and 25 girls) were treated at a pediatric teaching hospital during an 18-month period with a protocol of intralesional bleomycin, 0.3 to 0.6 mg/kg (per dose), administered under general anesthesia. The lesions were measured and photographed serially. Complications were also recorded. RESULTS The mean age of the children was 20 months (range, 3 months to 8 years) and the mean number of injections given was five (range, three to eight). The mean total dose administered was 13.6 mg (range, 1.4 to 25 mg). Outcome was assessed by a panel of five plastic surgeons. Twenty-two children were assessed as achieving a response of greater than 75 percent reduction in the size of the hemangioma (of which 10 children were assessed as having total involution >90 percent response). In seven children, there was a 50 to 75 percent reduction in size of the hemangiomas, and one child was judged to have a 25 to 50 percent reduction in size of the hemangioma. Hyperpigmentation was the most common complication, and occurred in 13 children. The mean follow-up period was 14 months (range, 3 to 35 months). CONCLUSIONS Intralesional bleomycin is another method with which to treat hemangiomas in children and may be particularly helpful for large hemangiomas of the head and neck. Repeated general anesthetics are required, and scarring with hyperpigmentation may occur.
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Affiliation(s)
- Conrad Pienaar
- Department of Plastic Surgery, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
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Affiliation(s)
- Alex Zvulunov
- Department of Pediatrics, Joseftal Hospital, Eilat, Israel.
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