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Das D, Sardar S, Nivetaa R. A Study on Clinico-Pathological Presentation and Management Prospective of Venolymphatic Malformation. Indian J Otolaryngol Head Neck Surg 2024; 76:687-694. [PMID: 38440618 PMCID: PMC10908698 DOI: 10.1007/s12070-023-04253-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/20/2023] [Indexed: 03/06/2024] Open
Abstract
To evaluate the clinical perspective of Veno lymphatic malformation and definitive management in respect to outcome. (1) To discuss clinical presentation, symptomatology of Veno lymphatic malformation. (2) Demonstration of radiological features, diagnosis and management of Veno lymphatic malformation with its complication. This prospective study was conducted on four patients attending ENT-OPD of R.G.Kar Medical College, Kolkata, India who had presented with suspected vascular malformation. The study was conducted from March 2021 to March 2023 for a period of 2 years. The patients were subjected to detailed history and examination. The diagnosis of the Veno lymphatic malformation was based on the results of Doppler ultrasonography, computed tomography and magnetic resonance imaging. In our study there was male predominance. Most of the patients belonged to the 2nd and 3rd decade of life. The main sites of involvement were lateral neck followed by parotid region. The lesion size ranged in between 3.5 × 3.5 cm and 7 × 5 cm. The patient with parotid lesion was found to have phlebolith. Since most of the lesions were small with well-defined margins, we were able to excise the lesions completely without leaving any residue. Out of four cases one patient developed temporary paresis of spinal accessory nerve which resolved eventually. Veno lymphatic malformations are rare and there is no definitive protocol for management and to be individualized. Our study will be helpful for furthering the existing knowledge regarding the management of Veno lymphatic lesion emphasizing the need of multimodality approach in surgical decision making.
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Affiliation(s)
- Debabrata Das
- Department of E.N.T, R.G. Kar Medical College, Kolkata, India
| | - Subhadip Sardar
- Department of E.N.T, R.G. Kar Medical College, Kolkata, India
| | - R. Nivetaa
- Department of E.N.T, R.G. Kar Medical College, Kolkata, India
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Patil UA. Application of Lasers in Vascular Anomalies. Indian J Plast Surg 2023; 56:395-404. [PMID: 38026771 PMCID: PMC10663075 DOI: 10.1055/s-0043-1775871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Laser technology has significantly improved giving better results, which in turn has led to an increase in the indications for laser therapy. Vascular anomalies comprise vascular tumors and malformations. They are classified according to the type of vessels involved including arteries, capillaries, postcapillary venules, veins, lymphatic vessels, and a combination of two or more of these. Laser needs a chromophore to get absorbed and act. Hemoglobin, both oxy and deoxy, is one of the naturally occurring chromophore that is abundant in vascular lesions. Therefore, in most of the vascular lesions, lasers can bring improvement of a varying degree, while for superficial hemangiomas and port wine stain (PWS) laser treatment is now the standard of care. However, even though there is increase in the use of lasers in clinical practice, many surgeons are still unaware of its versatility and they are unsure about its safety. This article provides a brief overview of laser and intense pulsed light (IPL) technology, and describes the key principles in using these energy sources in vascular malformations. Readers are also familiarized with possible adverse effects and measures to prevent and treat them.
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Affiliation(s)
- Uddhav Anandrao Patil
- Dr. D. Y. Patil Medical College and Hospital, Kolhapur, Maharashtra, India
- LakshyaKiran Therapeutic Lasers and Research Institute Pvt. Ltd. Kolhapur, Maharashtra, India
- Savitribai Phule Corporation Hospital, Kolhapur, Maharashtra, India
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DeHart AN, Richter GT. Laser Treatment of Vascular Anomalies. Dermatol Clin 2022; 40:481-487. [DOI: 10.1016/j.det.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bertino F, Trofimova AV, Gilyard SN, Hawkins CM. Vascular anomalies of the head and neck: diagnosis and treatment. Pediatr Radiol 2021; 51:1162-1184. [PMID: 33860862 DOI: 10.1007/s00247-021-04968-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/27/2020] [Accepted: 01/07/2021] [Indexed: 01/19/2023]
Abstract
Vascular malformations and vascular tumors comprise the two specific subsets of vascular anomalies that arise as a result of disorganized angiogenesis and neoplasm, respectively. Malformations are separate entities from vascular tumors (e.g., hemangiomas) and are recognized by the International Society for the Study of Vascular Anomalies (ISSVA) as such. Vascular malformations are classified into four main groups: simple, combined, anomalies of major vessels, and those associated with other vascular anomalies. Vascular tumors are neoplastic growths of blood vessels and are morphologically and molecularly distinct from malformations but can arise in the head and neck and have syndromic association. Head and neck vascular anomalies are not uncommon in the pediatric population and require special care in the workup, diagnostic imaging and clinical care. The purpose of this manuscript is to discuss the diagnosis and management of the most common intracranial and extracranial vascular malformations and tumors in the head and neck in children and adolescents.
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Affiliation(s)
- Frederic Bertino
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA.
| | - Anna V Trofimova
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA
| | - Shenise N Gilyard
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA
| | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA.,Division of Pediatric Radiology, Division of Interventional Radiology and Image Guided Medicine, Children's Healthcare of Atlanta, Emory + Children's Pediatric Institute, Atlanta, GA, USA
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Araslanova R, O TMJ, Waner M. Endoscopic Multimodal Approach to the Treatment of Airway Venous Malformations. Laryngoscope 2021; 131:E521-E524. [PMID: 32533772 DOI: 10.1002/lary.28730] [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: 11/30/2019] [Revised: 04/03/2020] [Accepted: 04/17/2020] [Indexed: 11/11/2022]
Abstract
View Video S1
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Affiliation(s)
- Rakhna Araslanova
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, New York
- Vascular Birthmark Institute of New York, Lenox Hill and Manhattan Eye, Ear, and Throat Hospitals, New York, New York
| | - Teresa Min-Jung O
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, New York
- Vascular Birthmark Institute of New York, Lenox Hill and Manhattan Eye, Ear, and Throat Hospitals, New York, New York
| | - Milton Waner
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, New York
- Vascular Birthmark Institute of New York, Lenox Hill and Manhattan Eye, Ear, and Throat Hospitals, New York, New York
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Aesthetic Treatment Outcomes of Capillary Hemangioma, Venous Lake, and Venous Malformation of the Lip Using Different Surgical Procedures and Laser Wavelengths (Nd:YAG, Er,Cr:YSGG, CO 2, and Diode 980 nm). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228665. [PMID: 33266374 PMCID: PMC7700507 DOI: 10.3390/ijerph17228665] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 12/30/2022]
Abstract
Different approaches with different clinical outcomes have been found in treating capillary hemangioma (CH), venous lake (VL), or venous malformations (VM) of the lips. This retrospective study aims to assess scar quality, recurrence rate, and patient satisfaction after different surgeries with different laser wavelengths. A total of 143 patients with CH or VM were included. Nd:YAG laser was used for 47 patients, diode 980 nm laser was used for 32 patients (treatments by transmucosal photo-thermo-coagulation), Er,Cr:YSSG laser was used for 12 patients (treatments by excision), and CO2 laser was used for 52 patients (treatments by photo-vaporization). The Manchester scar scale was used by practitioners to assess the scar quality. The recurrence rate and patients' satisfaction were noted at different follow-ups during 12 months. Our retrospective study showed that laser-assisted aesthetic treatment of vascular lesions (CH, VL, and VM) of the lips can be considered effective regardless of the wavelength used (Er,Cr:YSGG, CO2, Nd:YAG, and diode 980 nm) or the treatment procedure (transmucosal photo-thermo-coagulation, photo-vaporization, and surgical excision). There was no significant difference in patient and practitioner satisfaction with aesthetic outcome at 6 months follow-up. Furthermore, the treatments of lip vascular lesions performed using Er,Cr:YSGG and CO2 lasers did not show any recurrence during the 12 months of follow-up, while recurrence rates of 11% ± 1.4% and 8% ± 0.9% were seen in the diode and Nd:YAG groups, respectively.
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Spradley TP, Johnson AB, Wright HD, Kincannon JM, Richter GT. Gentle ND:YAG Laser Therapy in the Treatment of Cutaneous Venous Malformations. Facial Plast Surg Aesthet Med 2020; 23:289-293. [PMID: 32856950 DOI: 10.1089/fpsam.2020.0268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Venous malformations (VMs) are congenital vascular malformations that grow progressively and never resolve on their own. Cutaneous VMs are difficult to treat due to risk of injury and deformation. The purpose of this study was to examine the safety and efficacy of a modified neodymium-doped yttrium aluminum garnet laser (Gentle YAG) in the management of cutaneous VMs. Methods: Retrospective chart review of patients undergoing Gentle YAG therapy for cutaneous VMs and a blind prospective evaluation of photographs, performed by 10 reviewers, before and after treatment for growth, stability, improvement, or resolution of VMs. Results: Forty-five patients (18 males and 27 females) who underwent Gentle YAG therapy for a cutaneous VM were identified. Based on photographic review, Gentle YAG therapy elicited improvement in the appearance of VMs in 72% of the patients, χ2 (1, N = 45) = 25.94, p < 0.0001, with reviewers noting complete resolution in 8.2%, significant improvement in 34.5%, some improvement in 29.3%, and no growth or improvement in 20.9% of patients. Growth of the VM was noted in 7.3% of patients. Three (6.7%) patients reported complications from the treatment, which included infection, bleeding, blister, and color change. Four patients (8.9%) reported pretreatment pain, which resolved in three (75.0%) after treatment. Conclusions: Gentle YAG therapy can provide safe and effective treatment for cutaneous VMs and should be considered in the multimodal management of VMs.
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Affiliation(s)
- Thomas Ples Spradley
- Department of Otolaryngology and Head and Neck Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Research Hospital and Research Institute, Little Rock, Arkansas, USA
| | - Adam B Johnson
- Department of Otolaryngology and Head and Neck Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Research Hospital and Research Institute, Little Rock, Arkansas, USA
| | - Heather D Wright
- Department of Otolaryngology and Head and Neck Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Research Hospital and Research Institute, Little Rock, Arkansas, USA
| | - Jay M Kincannon
- Department of Otolaryngology and Head and Neck Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Research Hospital and Research Institute, Little Rock, Arkansas, USA
| | - Gresham T Richter
- Department of Otolaryngology and Head and Neck Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Research Hospital and Research Institute, Little Rock, Arkansas, USA
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Efficacy and Safety of the 532-nm KTP and Long-Pulsed 1064-nm Neodymium-doped Yttrium Aluminum Garnet Laser for Treatment of Vascular Malformations. Dermatol Surg 2020; 46:1535-1539. [DOI: 10.1097/dss.0000000000002386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Uppada U, Kiran BSR, Tiwari P, Rapolu K. A novel approach in managing an arteriovenous malformation of head and neck region using sclerotherapy. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2020. [DOI: 10.4103/jclpca.jclpca_29_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Venous malformations of the head and neck: A retrospective review of 82 cases. Arch Plast Surg 2019; 46:23-33. [PMID: 30685938 PMCID: PMC6369043 DOI: 10.5999/aps.2018.00458] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 10/20/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Venous malformations (VMs) are a common type of vascular malformation. However, their causes and management remain unclear, and few studies specific to VMs of the head and neck have been reported. This study describes our experiences with VMs of the head and neck. METHODS This retrospective study included 82 patients who underwent treatment for head and neck VMs, among 222 who visited our vascular anomalies center. Medical records between 2003 and 2016 were reviewed to identify common features in the diagnosis and treatment. The diagnosis of suspected head and neck VMs was based on the results of imaging studies or biopsies, and the VMs were analyzed based on magnetic resonance imaging, computed tomography, and Doppler sonography findings. RESULTS VMs were slightly more common in female patients (59.8%), and 45.1% of patients developed initial symptoms at the age of 10 or younger. Lesions were slightly more common on the right side (47.3%). The main sites involved were the cheek (27.7%) and lip area (25.5%). The muscle layer was commonly involved, in 98.7% of cases. Small lesions less than 5 cm in diameter accounted for 60.8% of cases, and well-defined types were slightly more prevalent at 55.4%. Improvement was observed in 77.1% of treated patients. CONCLUSIONS Early and accurate diagnosis and appropriate treatment according to individual symptoms are important for successful treatment of VMs. If treatment is delayed, the lesions can worsen, or recurrence becomes more likely. Therefore, VMs require a multidisciplinary approach for early and accurate diagnosis.
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Abstract
Hemangioma is a congenital vascular soft tissue tumor, defined as a vascular lesion present in the newborn, with a progressive developmental pattern related to age. It has a progressive and regressive periodic growth mode, in comparison with arteriovenous malformation (AVM). Although there are many treatment approaches for curing this lesion such as; surgery, cryotherapy, sclerosant agents, laser therapy has more advantages in comparison to the other methods. Such as, hemostasis and clean operating field, decreased amount of pain and edema. There are many types of lasers manufactured that could be used for therapeutic purposes. This article focuses on different types of laser applications in the treatment of these lesions.
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Affiliation(s)
- Ehsan Azma
- Oral and Maxillofacial Medicine of Dental Faculty of Guilan Medical University, Guilan, Iran
| | - Melika Razaghi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Gregory S, Burrows PE, Ellinas H, Stadler M, Chun RH. Combined Nd:YAG laser and bleomycin sclerotherapy under the same anesthesia for cervicofacial venous malformations: A safe and effective treatment option. Int J Pediatr Otorhinolaryngol 2018; 108:30-34. [PMID: 29605361 DOI: 10.1016/j.ijporl.2018.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/03/2018] [Accepted: 02/03/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Extensive cervicofacial venous malformations (VM) pose significant challenges to a patient's quality of life (altered breathing, dysphagia, dysarthria). Treatment options include: 1) Surgical debulking; 2) Sclerotherapy; 3) laser therapy; or 4) Combined modalities. Recent studies have demonstrated the importance of multimodality and multidisciplinary management of these patients. However, no studies have described combined single anesthetic laser and sclerotherapy treatment. We sought to demonstrate the safety and efficacy of combined Nd:YAG laser and sclerotherapy under the same anesthetic administration. METHODS Retrospective review of 8 patients (Age 6 mo -74 yrs, x͂ 31) with extensive cervicofacial VM with significant airway involvement. Patients were treated with combined suspension laryngoscopy with Nd:YAG laser of airway VM followed by image guided direct puncture sclerotherapy using bleomycin in the airway VM and sodium tetradecyl sulfate (STS) foam in the cervicofacial VM during the same anesthetic encounter. RESULTS All 8 patients had extensive cervicofacial VMs that were symptomatic with snoring or orthopnea. Four of the patients had previously been treated at outside institutions with residual disease or significant complications. All patients remained intubated post procedure (Avg. 1.07 days) and tolerated extubation without re-intubation or any major complications. The average length of hospital stay was 3.2 days, of which 1.9 days were spent in the ICU. Patients reported symptomatic improvement or had decreased VM disease on MRI follow up. CONCLUSION Combined Nd:YAG laser therapy and sclerotherapy allows treatment of both superficial and deep components of VMs in a safe and efficient manner. In addition, suspension laryngoscopy provides improved visualization and access for the interventional radiologist in difficult to reach areas for sclerotherapy.
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Affiliation(s)
- Stacie Gregory
- Department of Surgery, Division of Otolaryngology, Southern Illinois University School of Medicine, Springfield, IL, United States.
| | - Patricia E Burrows
- Department of Vascular and Interventional Radiology, MCW, Milwaukee, WI, United States.
| | | | - Michael Stadler
- Department of Otolaryngology, Medical College of Wisconsin (MCW), Milwaukee, WI, United States.
| | - Robert H Chun
- Department of Otolaryngology, Medical College of Wisconsin (MCW), Milwaukee, WI, United States.
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Shigematsu T, Sorscher M, Dier EC, Berenstein A. Bleomycin sclerotherapy for eyelid venous malformations as an alternative to surgery or laser therapy. J Neurointerv Surg 2018; 11:57-61. [PMID: 29674482 DOI: 10.1136/neurintsurg-2018-013813] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the clinical outcome of patients with venous malformation (VM) involving the eyelid treated with bleomycin sclerotherapy. METHODS A retrospective review was performed of 18 consecutive patients with VM involving the eyelid who underwent bleomycin sclerotherapy. Patients' clinical presentation, details of sclerotherapy, and post-sclerotherapy resolution of the lesion as well as any procedure-related complications were evaluated. RESULTS Twelve women and six men of mean age 34.3±20.4 years underwent sclerotherapy with bleomycin. Chief complaints were cosmetic disfigurations with or without hemifacial deformity (n=2), pain in engorgement area (n=2), pain and swelling from venous thrombosis (n=2), swelling or engorgement obstructing their eyesight (n=2), or eyelid dysfunction (n=1). The lesions were only in the eyelid in three patients; otherwise they were extended out of the eyelid either superiorly (n=3), laterally (n=8), inferiorly (n=8), and/or posteriorly to the orbit (n=8) to various extents. Conjunctival involvement was present in 13 patients. 14 patients had received prior treatments including surgery, laser therapy, or non-bleomycin sclerotherapy. With an average three sessions of bleomycin sclerotherapy (average total dose 34.5 mg), more than 80% shrinkage was observed in seven patients (38.9%), 50-80% shrinkage in eight patients (44.4%), and 30-50% shrinkage in two patients (11.1%). One patient had recurrence, which was successfully treated again with bleomycin. No procedure-related complications were noted. CONCLUSIONS The use of bleomycin appears to be a simple, safe, and effective treatment for venous malformations involving the eyelid, avoiding more elaborate and challenging surgical or laser interventions, and is even effective in full thickness lesions.
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Affiliation(s)
- Tomoyoshi Shigematsu
- Department of Neurosurgery, Cerebrovascular Center, Mount Sinai Health System, New York City, New York, USA
| | - Michelle Sorscher
- Department of Neurosurgery, Cerebrovascular Center, Mount Sinai Health System, New York City, New York, USA
| | - Evelyn C Dier
- Department of Neurosurgery, Cerebrovascular Center, Mount Sinai Health System, New York City, New York, USA
| | - Alejandro Berenstein
- Department of Neurosurgery, Cerebrovascular Center, Mount Sinai Health System, New York City, New York, USA
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Utility and tolerability of the long-pulsed 1064-nm neodymium:yttrium-aluminum-garnet (LP Nd:YAG) laser for treatment of symptomatic or disfiguring vascular malformations in children and adolescents. J Am Acad Dermatol 2017; 77:473-479. [DOI: 10.1016/j.jaad.2017.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 04/11/2017] [Accepted: 04/13/2017] [Indexed: 12/26/2022]
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Neodymium-Doped Yttrium Aluminium Garnet Laser Treatment of Pediatric Venous Malformation in the Oral Cavity. Dermatol Surg 2017; 42:875-9. [PMID: 27243133 DOI: 10.1097/dss.0000000000000770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Treatment of venous malformations in the orofacial region remains a challenge. Laser therapy is an alternative treatment in inoperable cases. OBJECTIVE To retrospectively evaluate the effectiveness and complications associated with neodymium-doped yttrium aluminium garnet (Nd:YAG) laser treatment of oral venous malformations. MATERIALS AND METHODS A total of 10 children (mean age: 7.3 years; range: 10 months-15 years) with oral venous malformation were treated with Nd:YAG laser during 2005 to 2013. Clinical improvement, including degree of color lightening and size reduction, and treatment complications, including dyspigmentation, textural change, and scarring were evaluated. RESULTS Color clearing of 51% to 75% and >75% was seen in 25% and 45% of patients, respectively. Size reduction of 25% to 50%, 51% to 75%, and >75% was observed in 30%, 15%, and 45% of patients, respectively. Mild and moderate scarring was observed in 15% and 5% of cases, respectively. CONCLUSION Nd:YAG laser is a promising alternative treatment in pediatric patients with inoperable venous malformations in the oral cavity. Mild to moderate scarring was the most common complication.
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Understanding venous malformations of the head and neck: a comprehensive insight. Med Oncol 2017; 34:42. [PMID: 28181207 DOI: 10.1007/s12032-017-0896-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/23/2017] [Indexed: 01/10/2023]
Abstract
Venous malformations (VMs) are congenital vascular malformations. They are very often misnamed and thus incorrectly managed. The aim of the present paper is to provide the reader with the most updated literature available and to offer a detailed description of each single aspect of this disease. In detail, the paper discusses the epidemiology, the embryological origins and the physiopathology of VMs. Then, the clinical features of sporadic, inherited and syndromic VMs are discussed. The instrumental diagnosis is presented, and the role of US, CT, MRI and phlebography is pointed out. Differential diagnoses with other vascular malformations and tumors are described. The clinical session ends with the staging of VMs relying on MRI and rheological features. All aspects of treatment are described: conservative measures, medical treatment, sclerotherapy, laser and surgery are thoroughly discussed. A section is reserved to bony VMs. Their clinical aspects and the appropriate treatment are presented.
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Durr ML, Meyer AK, Kezirian EJ, Mamlouk MD, Frieden IJ, Rosbe KW. Sleep-disordered breathing in pediatric head and neck vascular malformations. Laryngoscope 2017; 127:2159-2164. [DOI: 10.1002/lary.26468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 10/21/2016] [Accepted: 11/21/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Megan L. Durr
- Department of Otolaryngology-Head and Neck Surgery; Kaiser Permanente Medical Center; Oakland California U.S.A
| | - Anna K. Meyer
- Department of Otolaryngology Head and Neck Surgery; Univerisity of California San Francisco; San Francisco California U.S.A
| | - Eric J. Kezirian
- Department of Otolaryngology-Head and Neck Surgery; University of Southern California Caruso; Los Angeles California U.S.A
| | - Mark D. Mamlouk
- Department of Radiology; Kaiser Permanente Medical Center; Santa Clara California U.S.A
| | - Ilona J. Frieden
- Departments of Dermatology and Pediatrics; Univerisity of California San Francisco; San Francisco California U.S.A
| | - Kristina W. Rosbe
- Department of Otolaryngology Head and Neck Surgery; Univerisity of California San Francisco; San Francisco California U.S.A
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Commentary on Neodymium-Doped Yttrium Aluminium Garnet Laser Treatment of Pediatric Venous Malformation in the Oral Cavity. Dermatol Surg 2016; 42:880-2. [PMID: 27191779 DOI: 10.1097/dss.0000000000000737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Treatment of venous lesions of the lips and perioral area with a long-pulsed Nd:YAG laser. Br J Oral Maxillofac Surg 2016; 54:376-8. [DOI: 10.1016/j.bjoms.2015.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 06/13/2015] [Indexed: 11/19/2022]
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Diode endovascular laser treatment in venous malformations of the upper aerodigestive tract. J Craniomaxillofac Surg 2016; 44:533-7. [DOI: 10.1016/j.jcms.2016.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/24/2016] [Accepted: 02/08/2016] [Indexed: 11/23/2022] Open
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Combined Intralesional Neodymium-Doped Yttrium Aluminium Garnet Laser and Intratumoral Ligation as Curative Treatment for Craniofacial Arteriovenous Malformations. J Craniofac Surg 2016; 27:445-9. [PMID: 26825744 DOI: 10.1097/scs.0000000000002382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Craniofacial arteriovenous malformation (AVM), although very rare, has been a very difficult problem to treat especially when it is large and involves important structures. Surgical resection often results in unacceptable complications but still not curative. At our institution, treatment by combined intralesional neodymium-doped yttrium aluminium garnet laser and intratumoral ligation has been successful in venous malformation. This minimally invasive technique was then applied to more challenging AVM on the head and neck. Disease control was studied using clinical parameters and magnetic resonance imaging.Four patients with moderate-to-severe (Schobinger 2-4) craniofacial AVM were treated by this technique from 2001 to 2011. Patient age ranged from 2 to 51 years (mean: 25 years). After 2 to 4 treatments and follow-up period of 1456 days, 3 (75%) were cured. One of them was infant with huge mass and secondary pulmonary hypertension. Clinical cure was achieved after 3 treatments without residual cardiovascular compromise. The other patient (25%) had cheek mass with intraorbital involvement. The authors did not treat periorbital lesion so as to avoid triggering intraorbital spreading. The rest of the cheek lesion was clinically and radiologically cured.Laser energy setting, ablative technique, and skin cooling are the main factors determining the success. Individualized laser settings and properly set endpoints can increase treatment effectiveness in shorter period. In conclusion, this minimally invasive technique was successful in curing AVM without complication. With more clinical study and development of soft tissue monitoring tools, it is possible that intralesional laser could become the treatment of choice for all cutaneous AVM.
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Abstract
Advances in laser technology in recent decades have increased the options for the treatment of dermatologic conditions of the eye and eyelid. Benign tumors can be laser-ablated with relative ease, and vascular and melanocytic lesions can be precisely targeted with modern lasers. In this contribution, we review treatment of periocular pigmented lesions, including melanocytic nevi and nevus of Ota; vascular lesions including telangiectasias, port wine stains, and infantile hemangiomas; hair removal; eyeliner tattoo removal; laser ablation of common benign periocular tumors, such as syringomas, xanthelasma, milia, and seborrheic keratoses; and laser resurfacing. The recent advent of fractionated laser technology has resulted in dramatically decreased healing times for periocular skin resurfacing and fewer adverse effects. Fractionated laser resurfacing has now nearly supplanted traditional full-field laser resurfacing, and safe treatment of rhytides on the thin skin of the eyelids is possible. Proper eye protection is, of course, essential when using lasers near the eye. Patient preparation, safety precautions, and risks--intraocular and extraocular--are discussed herein. As laser technology continues to advance, we are sure to see improvements in current treatments, as well as development of new applications of cutaneous lasers.
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Affiliation(s)
- Breton Yates
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, Farmington, Connecticut
| | - Syril Keena T Que
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, Farmington, Connecticut
| | - Logan D'Souza
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, Farmington, Connecticut
| | - Jeanine Suchecki
- Division of Ophthalmology, University of Connecticut Health Center, Department of Surgery, 263 Farmington Avenue, Farmington, Connecticut
| | - Justin J Finch
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, Farmington, Connecticut.
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Abstract
Intralesional laser therapy for the treatment of vascular malformations (VMs) has been previously reported for select patient populations. Larger studies, over a wider variety of indications, are needed to better define the potential role of this technology. In the current study, a 12-year, retrospective review of 44 patients who underwent 73 intralesional Nd:YAG or diode laser treatments of VMs was performed. The most commonly encountered lesions were venous malformations (66%) and the most commonly involved anatomic locations were the head and neck regions (41%) and lower extremity (39%). Primary indications for treatment were enlargement (73%) and pain (52%). Lesion size was reduced in 94% of cases after treatment and pain was improved in 91% of cases. Minor postoperative complications occurred in 16 (36%) patients. There was no difference in treatment response among various VM subtypes or anatomic locations (P=0.497, P=0.866) or in the incidence of complications (P=0.531, P=0.348). Age was the only factor associated with an increased risk of complications (odds ratio, 1.034; P=0.038). When used in accordance with the suggested guidelines, intralesional laser therapy is a safe and effective treatment modality for VMs of varying compositions and locations.
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Endoscopic transmucosal direct puncture sclerotherapy for management of airway vascular malformations. Laryngoscope 2015; 126:205-11. [DOI: 10.1002/lary.25284] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2015] [Indexed: 11/07/2022]
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Medeiros R, Silva IH, Carvalho AT, Leão JC, Gueiros LA. Nd:YAG laser photocoagulation of benign oral vascular lesions: a case series. Lasers Med Sci 2015; 30:2215-20. [DOI: 10.1007/s10103-015-1764-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 05/01/2015] [Indexed: 12/18/2022]
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Lee DR, Richter GT. Nasopharyngeal venous malformation: A rare condition managed with Nd:
YAG
laser. Laryngoscope 2015; 125:2405-7. [DOI: 10.1002/lary.25193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/08/2015] [Accepted: 01/13/2015] [Indexed: 11/08/2022]
Affiliation(s)
- David R. Lee
- College of MedicineUniversity of Arkansas for Medical SciencesLittle Rock Arkansas
| | - Gresham T. Richter
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Arkansas for Medical SciencesLittle Rock Arkansas
- Vascular Malformations Center of ExcellenceArkansas Children's HospitalLittle Rock Arkansas U.S.A
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Rosenberg TL, Richter GT. Lasers in the Treatment of Vascular Anomalies. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014. [DOI: 10.1007/s40136-014-0065-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Sofos S, Liew SH. The use of long pulsed neodymium-doped yttrium aluminum garnet for the treatment of paediatric venous malformations. Ann Dermatol 2014; 26:474-7. [PMID: 25143676 PMCID: PMC4135102 DOI: 10.5021/ad.2014.26.4.474] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/26/2013] [Accepted: 09/10/2013] [Indexed: 12/17/2022] Open
Abstract
Background Venous malformation in the pediatric population can present with pain, bleeding, or a debilitating deformity that can be difficult to manage. Sclerotherapy, surgery, and more recently, long pulsed neodymium-doped yttrium aluminum garnet (Nd : YAG) laser have been used with variable success rates. Objective Our aims and objectives, were to identify the specific group of patients that would benefit from this treatment. Methods A prospective clinical trial was carried out with 59 consecutive patients. The treatment criteria included a large facial deformity and painful or bleeding lesions. One to three treatments were administered at 6~8-week intervals. Results A total of 59 patients were treated. The average follow-up was 24 months. All patients achieved good to excellent results in pain and bleeding control as well as in the reduction of the size of lesions in the lip and oral mucosa. The treatment however, is not effective in reducing the size of large, relatively high-flow lesions in the limbs. Complications from treatment include skin blistering (n=4), ulceration (n=4), and subsequent hypertrophic scarring (n=3). Three patients had partial recurrence after a 3-year follow-up. Conclusion Complex venous malformations cannot be cured but can be symptomatically controlled with the long-pulsed Nd : YAG laser treatment. The treatment satisfaction is high, and there is a small but definite risk of scarring from treatment.
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Affiliation(s)
- Stratos Sofos
- Department of Plastic Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Se Hwang Liew
- Department of Plastic Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
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Alakailly X, Kummoona R, Quereshy FA, Baur DA, González AE. The use of sodium tetradecyl sulphate for the treatment of venous malformations of the head and neck. J Maxillofac Oral Surg 2014; 14:332-8. [PMID: 26028855 DOI: 10.1007/s12663-014-0623-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 02/25/2014] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Vascular malformations have devastating cosmetic effects in addition to being associated with pain and bleeding. Sclerotherapy has been used as an effective therapeutic modality for the management of vascular malformations. The purpose of this case series is to describe our clinical experience of using sodium tetradecyl sulphate (STS) 3 % in the treatment of venous malformation lesions of head and neck. MATERIALS AND METHODS Thirteen patients were included in this study (three male and ten female; age range between 8 months and 54 years; mean age 18.2 years, ±SD 15.71). The patients were treated by 3 % STS intralesional injections. Of the thirteen patients treated, complete resolution occurred in four patients (28.57 %), a good response occurred in five patients (35.7 %), a moderate response in two patients (14.28 %), a mild response in two patients (14.28 %) and no response in one patient (7.14 %). The side effects encountered in all patients were pain and edema after injection which was controlled by oral analgesics and an intramuscular injection of dexamethasone. In addition, two patients developed a superficial ulceration (11.76 %) which healed uneventfully, and one patient developed ecchymosis after injection (5.88 %). CONCLUSION Sclerotherapy with 3 % STS is a simple, safe, and effective modality for the treatment of venous malformations.
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Affiliation(s)
- Xena Alakailly
- Maxillofacial Surgery, Iraqi Board for Medical Specializations, Medical City, Baghdad, Iraq ; Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University Hospitals/Case Medical Center, 2124 Cornell rd., Cleveland, OH USA ; Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Case Western Reserve University, 2124 Cornell rd., Cleveland, OH 44106-4905 USA
| | - Raja Kummoona
- Maxillofacial Surgery, Iraqi Board for Medical Specializations, Medical City, Baghdad, Iraq
| | - Faisal A Quereshy
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University Hospitals/Case Medical Center, 2124 Cornell rd., Cleveland, OH USA
| | - Dale A Baur
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University Hospitals/Case Medical Center, 2124 Cornell rd., Cleveland, OH USA
| | - Ariadne E González
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University Hospitals/Case Medical Center, 2124 Cornell rd., Cleveland, OH USA
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Nguyen TV, Becker EM, Miller WA, Browning JC. Plaque-Type Glomuvenous Malformations Successfully Treated Using Combined Pulsed Dye Laser and Neodymium-Doped Yttrium Aluminum Garnet Laser. Dermatol Surg 2014; 40:89-92. [DOI: 10.1111/dsu.12363] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Grillo E, Boixeda P, Paoli J, Vano-Galván S, Carrillo R, Jaén P. Congenital plaque-like glomangioma treated successfully with dual wavelength pulsed-dye and neodymium:yttrium-aluminum-garnet laser. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2013; 29:212-4. [PMID: 23815354 DOI: 10.1111/phpp.12036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/05/2013] [Indexed: 11/28/2022]
Abstract
Glomovenous malformations are disseminated variants of cutaneous glomus tumors. These malformations are subdivided into regional or localized, disseminated, and congenital plaque-like forms. The congenital plaque-like form is the rarest variant. Most treatment modalities have been disappointing in the treatment of large glomangiomas, leading to high recurrence rates. We report a case of a 34-year-old man with a congenital plaque-like glomangioma on his left arm and forearm treated successfully with sequential pulsed-dye neodymium yttrium aluminum garnet laser.
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Affiliation(s)
- Emiliano Grillo
- Department of Dermatology, Ramon y Cajal University Hospital, University of Alcalá, Madrid, Spain.
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Nassiri N, O TMJ, Rosen RJ, Moritz J, Waner M. Staged endovascular and surgical treatment of slow-flow vulvar venous malformations. Am J Obstet Gynecol 2013; 208:366.e1-6. [PMID: 23395642 DOI: 10.1016/j.ajog.2013.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/21/2013] [Accepted: 02/03/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of the study was to report our experience in a rare series of treated symptomatic slow-flow vulvar venous malformations (VVMs) using a staged, multidisciplinary approach. STUDY DESIGN Consecutive patients with symptomatic lesions treated over a 7 year period (2005-2012) were followed up for technical success, resolution of symptoms, aesthetic outcomes, and complications. Direct endovenous sclerotherapy (DEVS) using sodium tetradecyl sulfate (STS) foam was performed in all patients under ultrasound and contrast-enhanced fluoroscopic guidance. Surgical excision and layered primary closure was performed within 24 hours after the last DEVS session. RESULTS Eleven patients (mean age, 25 years; range, 4-43 years) were treated. Presenting symptoms included pain (n = 11), soft tissue swelling (n = 11), local heaviness (n = 11), dyspareunia (n = 2), and dysmenorrhea (n = 2). Most were isolated lesions (n = 8). There were 2 cases of Klippel-Trénaunay syndrome and 1 case of Maffucci syndrome. The latter required Nd:YAG laser photocoagulation prior to sclerotherapy. On average, approximately 3 DEVS sessions were required prior to surgical excision (range, 1-6). Mean estimated surgical blood loss was 130 mL (range, 20-400 mL). Mean follow-up was 23 months (range, 3-55 months). Elimination of pain and soft tissue redundancy was achieved in all patients with satisfactory aesthetic outcomes. All patients experienced minor pain and swelling after DEVS. Following surgical excision, there was 1 case of hematoma and wound dehiscence requiring surgical evacuation. No other reinterventions, endovascular or surgical, were required. CONCLUSION VVMs require increased awareness and appropriate preoperative evaluation for proper identification and treatment. A multidisciplinary approach can provide improvement in clinical signs and symptoms with satisfactory cosmesis and minimal complications.
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Affiliation(s)
- Naiem Nassiri
- Lenox Hill Heart and Vascular Institute of New York, Lenox Hill Hospital, North Shore Long Island Jewish Health System, New York, NY, USA.
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Del Pozo J, Gómez-Tellado M, López-Gutiérrez J. Malformaciones vasculares en la infancia. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:661-78. [DOI: 10.1016/j.ad.2011.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 12/18/2011] [Accepted: 12/25/2011] [Indexed: 12/20/2022] Open
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Vascular Malformations in Childhood. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Alcántara-González J, Boixeda P, Pérez-García B, Truchuelo-Díez M, González-Muñoz P, Jaén-Olasolo P. Venous malformations treated with dual wavelength 595 and 1064 nm laser system. J Eur Acad Dermatol Venereol 2012; 27:727-33. [DOI: 10.1111/j.1468-3083.2012.04548.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stimpson P, Hewitt R, Barnacle A, Roebuck DJ, Hartley B. Sodium tetradecyl sulphate sclerotherapy for treating venous malformations of the oral and pharyngeal regions in children. Int J Pediatr Otorhinolaryngol 2012; 76:569-73. [PMID: 22341629 DOI: 10.1016/j.ijporl.2012.01.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 01/15/2012] [Accepted: 01/18/2012] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Venous vascular malformations in the head and neck region present a difficult management challenge. We describe our experience of using sodium tetradecyl sulphate injection sclerotherapy to treat children presenting with venous malformations of the oral and pharyngeal region. METHODS We performed a retrospective case note review of consecutive children treated at our institution between 2004 and 2011. Patient notes were analysed for demographic details, site and size of lesion, number and duration of treatments, treatment response and complications. RESULTS Twelve patients were included (7 boys and 5 girls, mean age 7 years). Sites of lesions included tongue, floor of mouth, pharynx, tonsillar fossae, parapharyngeal space and soft palate. All patients were treated with 3% sodium tetradecyl sulphate (STS) foam injected trans-orally or percutaneously under ultrasound or fluoroscopic guidance. The lesions had a mean volume of 4 ml (range 2-14 ml). An average of 3 treatments was required (range 1-9). In 4 patients a single treatment was sufficient. For those patients requiring multiple treatments, a mean of 4 treatments were required over an average period of 28 months. The overall response rate was 83% (10/12). Complete resolution was achieved in 4 cases (33%) with a significant reduction in size in a further 6 cases (50%). Larger lesions generally require more treatments than low volume lesions. Two cases recurred despite treatment. One patient suffered minor bleeding following transcutaneous injection. CONCLUSIONS Injection sclerotherapy using STS foam offers an effective treatment option when managing children presenting with venous malformations in the oral and pharyngeal. A single treatment may be adequate for small lesions but the procedure may be safely repeated until a satisfactory result is obtained.
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Affiliation(s)
- Paul Stimpson
- Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK.
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Nuño-González A, Naz-Villalba E, Vicente-Martín F, Sánchez-Gilo A, Gutiérrez-Pascual M, Gómez de la Fuente E, López-Estebaranz J. Treatment of Mucosal Vascular Malformations With Variable-Pulse Neodymium:Yttrium-Aluminum-Garnet Laser. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/j.adengl.2011.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Nuño-González A, Naz-Villalba E, Vicente-Martín F, Sánchez-Gilo A, Gutiérrez-Pascual M, Gómez de la Fuente E, López-Estebaranz J. Tratamiento de malformaciones vasculares de mucosas con láser Nd:YAG de pulso variable. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:717-21. [DOI: 10.1016/j.ad.2011.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 12/24/2010] [Accepted: 01/25/2011] [Indexed: 10/16/2022] Open
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Update on pediatric extracranial vascular anomalies of the head and neck. Childs Nerv Syst 2010; 26:1417-33. [PMID: 20697721 DOI: 10.1007/s00381-010-1202-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 06/11/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Vascular anomalies most frequently present at birth or in early childhood, and the craniofacial region is the most common site of involvement. A long history of misleading nomenclature born of confusion about the presentation and natural history of various vascular anomalies has made appropriate diagnosis difficult. The present article emphasizes the importance of clarity of nomenclature for proper diagnosis, both clinically and radiographically, to guide appropriate therapy. In addition, updates on clinical concepts, imaging, and treatment strategies will be discussed. Pediatric vascular anomalies can be divided into two broad categories: vascular tumors and vascular malformations. This biologic classification is based on differences in natural history, cellular turnover, and histology. An updated classification was introduced in 1996 by the International Society for the Study of Vascular Anomalies (ISSVA) to include infantile hemangioma variants, other benign vascular tumors, and combined lesions. Widespread confusion propagated throughout the literature and in clinical practice stems from the continued improper use of many of the terms used to describe vascular tumors and malformations ignoring their pathophysiology. This leads to errors in diagnosis and the dissemination of misinformation to patients and clinicians. Certain terms should be abandoned for more appropriate terms. The clinical presentation usually identifies what general type of vascular anomaly is present, either vascular tumor or vascular malformation. Imaging provides crucial information about the initial diagnosis and aids in follow-up. CONCLUSIONS Adoption and use of uniform nomenclature in the ISSVA classification system is the first vital step in correct diagnosis and treatment of often complicated vascular tumors and vascular malformations. A multidisciplinary team approach is necessary to provide optimal care for patients, and the necessity for specialists in all areas to communicate using standardized terminology cannot be overemphasized.
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Abstract
Vascular malformations are rare but important skin disorders in children, which often require multidisciplinary care. The goal of this article is to orient pediatricians to the various types of vascular malformations. We discuss the clinical characteristics, diagnostic criteria, and management of capillary, venous, arteriovenous, and lymphatic malformations. Associated findings and syndromes are also discussed briefly.
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Affiliation(s)
- Jennifer T Huang
- Department of Dermatology, Harvard Medical School, c/o Massachusetts General Hospital, Boston, MA 02114, USA
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Alcántara-González J, Boixeda P, Fuentelsaz-del Barrio V, Jiménez-Bellinga R. Malformación venosa oral tratada con aplicación secuencial de láser de colorante pulsado y Nd:YAG. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2010.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Eivazi B, Wiegand S, Teymoortash A, Neff A, Werner JA. Laser treatment of mucosal venous malformations of the upper aerodigestive tract in 50 patients. Lasers Med Sci 2010; 25:571-6. [PMID: 20217166 DOI: 10.1007/s10103-010-0762-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 01/19/2010] [Indexed: 11/24/2022]
Abstract
We examined the clinical appearance of mucosal venous malformations of the upper aerodigestive tract with regard to their accessibility to laser therapy and further assessed the value of treatment of these lesions with the Nd:YAG and CO(2) lasers. A retrospective study was performed in 50 patients who had undergone laser treatment for mucosal low-flow vascular malformations of the upper aerodigestive tract. Records were reviewed for demographic data, extent of the lesion, treatment modality, required number of therapy sessions and the therapeutic outcome. Follow-up was performed by postinterventional clinical examination and additional interview by phone for current status. Between 1 July 2001 and 30 September 2008 32 women and 18 men received laser treatment and were followed up until 30 June 2009. The lesions were classified into three grades according to their extent and clinical presentation, as follows: grade 1 <2 cm, asymptomatic or mild symptoms; grade 2 2-4 cm, asymptomatic or mild symptoms; and grade 3 > or =4 cm or multiple locations (more than two) or severe symptoms such as dyspnoea, pain or dysphagia. Of the 50 patients, 13 (26%) were classified as having grade 1 disease, 22 (44%) grade 2 disease, and 15 (30%) grade 3 disease. Treatment in 39 patients was solely with the Nd:YAG laser using the noncontact or interstitial technique. Resection using the CO(2) laser was performed in six patients, and combined conventional surgery and Nd:YAG laser therapy in five patients. The applied grading reflects the extent of laser therapy and also the number of therapy sessions performed in patients treated with the Nd:YAG laser. Resection with the CO(2) laser is suitable for grade 1 lesions. In advanced lesions a combined therapeutic approach and multiple sessions are necessary. The Nd:YAG laser is still a valuable therapeutic tool for the treatment of venous malformations of the mucosa.
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Affiliation(s)
- Behfar Eivazi
- Department of Otorhinolaryngology, Head and Neck Surgery, Philipps-University of Marburg, Marburg, Germany.
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Glade RS, Richter GT, James CA, Suen JY, Buckmiller LM. Diagnosis and management of pediatric cervicofacial venous malformations: retrospective review from a vascular anomalies center. Laryngoscope 2010; 120:229-35. [PMID: 20013849 DOI: 10.1002/lary.20715] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Venous malformations are rare congenital aberrations of vein development frequently presenting in the head and neck. Without treatment, venous malformations cause progressive disfigurement, dysfunction, and bleeding. In this study, we analyzed a cohort of pediatric patients with cervicofacial venous malformations (CFVM), with the goal of developing a treatment algorithm for these complex lesions. STUDY DESIGN Eleven-year retrospective chart review. The setting was a vascular anomalies center at a pediatric tertiary hospital. Nineteen patients (10 male, 9 female), aged 11 months to 17 years, presented with CFVM. METHODS Patient charts were reviewed for demographics, signs and symptoms, timing of first and subsequent interventions, total number and type of interventions performed, and procedural complications. A family questionnaire supplemented outcome measures by determining the perception of disease control. RESULTS Presenting symptoms for CFVM include growth (100%), disfigurement (63%), pain (58%), respiratory compromise (42%), and dysphagia (32%). A mean of 6.7 interventions were performed per patient (median, 6; range, 2-12), requiring a mean of 0.8 excisions, 4.6 laser treatments, and 1.3 sclerotherapy injections. Average age at first procedure was 8.5 years. Time between treatments averaged 8.9 months. Four complications occurred in 127 procedures (3.1%). Questionnaire responses indicated subjective improvement following therapy. A management algorithm could be developed from therapeutic outcomes. CONCLUSIONS Treatment of CFVM can be safely and successfully performed with a combination of laser therapy, sclerotherapy, and surgical excision. A treatment algorithm involving multiple procedures during childhood can lead to successful management of CFVM.
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Affiliation(s)
- Robert S Glade
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital at OU Medical Center, Oklahoma City, Oklahoma, USA
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Alcántara-González J, Boixeda P, Fuentelsaz-del Barrio V, Jiménez-Bellinga R. Oral Venous Malformation Treated with Pulsed-Dye and Neodymium: Yttrium-Aluminum-Garnet Sequential Laser. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Treatment of Vascular Lesions of the Tongue with Nd:YAG Laser. Case Rep Med 2009; 2009:795363. [PMID: 20069040 PMCID: PMC2797754 DOI: 10.1155/2009/795363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 11/17/2009] [Indexed: 12/05/2022] Open
Abstract
The treatment of vascular lesions of the tongue is a very challenging procedure since the maintenance of the lingual tissue is of critical importance. Numerous treatment options have been described in literature but the Nd:YAG Laser appears to be one of the safest therapeutic options. We described a successful treatment of vascular lesions of the tongue with an excellent clinical result after only one treatment session with the Nd:YAG laser, with conservation of the lingual tissue and its functionality.
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Pereyra-Rodríguez JJ, Boixeda P, Pérez-Carmona L, Vañó-Galvan S. Successful treatment of large venous malformation with dual wavelength 595 and 1064 nm system. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2009; 25:283-4. [DOI: 10.1111/j.1600-0781.2009.00449.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Del Pozo J, Martínez‐González C, Verea MM, Fernández‐Torres R, Fonseca E. Venous malformations with lip involvement: Palliative treatment with carbon dioxide laser vaporization in five cases. J COSMET LASER THER 2009; 11:14-8. [DOI: 10.1080/14764170802612950] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fornaini C, Bertrand C, Bonanini M, Rocca JP, Nammour S. Welding in the Dental Office by Fiber-Delivered Laser: A New Technique. Photomed Laser Surg 2009; 27:417-23. [PMID: 19569953 DOI: 10.1089/pho.2008.2273] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Carlo Fornaini
- TELEO Laboratory, Faculty of Dentistry, University of Nice-Sophia Antipolis, Nice, France
- Dental School, Faculty of Medicine, University of Parma, Parma, Italy
- Department of Dental Sciences, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Caroline Bertrand
- TELEO Laboratory, Faculty of Dentistry, University of Nice-Sophia Antipolis, Nice, France
| | - Mauro Bonanini
- Dental School, Faculty of Medicine, University of Parma, Parma, Italy
| | - Jean-Paul Rocca
- TELEO Laboratory, Faculty of Dentistry, University of Nice-Sophia Antipolis, Nice, France
| | - Sam Nammour
- Department of Dental Sciences, Faculty of Medicine, University of Liège, Liège, Belgium
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Andreisek G, Nanz D, Weishaupt D, Pfammatter T. MR imaging-guided percutaneous sclerotherapy of peripheral venous malformations with a clinical 1.5-T unit: a pilot study. J Vasc Interv Radiol 2009; 20:879-87. [PMID: 19481473 DOI: 10.1016/j.jvir.2009.03.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 02/22/2009] [Accepted: 03/09/2009] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate the feasibility of magnetic resonance (MR) imaging-guided percutaneous sclerotherapy of venous malformations (VMs) by using a clinical 1.5-T MR unit and the safety and therapeutic outcome of the performed procedures. MATERIALS AND METHODS This is a prospective pilot study with ethical approval and written informed patient consent. Ten MR imaging-guided percutaneous sclerotherapy treatments were performed in 10 patients (one male and nine female patients; age range, 16-47 years; mean age, 30.3 years) with a VM in the foot and/or ankle (n = 5), calf (n = 2), thigh and/or knee (n = 2), and elbow (n = 1). MR imaging was used for needle insertion guidance and real-time monitoring of the injection process by using three-dimensional fast spoiled gradient-echo MR sequences (repetition time msec/echo time msec = 3.7-5.2/1.1-1.6, flip angle = 35 degrees) and meglumine gadoterate/ethanol solutions as the sclerosing agent. The technical success (ie, absence of technical problems, number of needle position corrections) was systematically evaluated along with safety aspects (ie, absence of complications) and the therapeutic outcome (eg, VM volume decrease, relief of symptoms) during a 1-year follow-up period. RESULTS MR imaging-guided sclerotherapy was technically successful in all patients. A mean of 2.5 +/- 1.85 (range, 1-6) needle position corrections were needed for correct needle placement. The distribution of the sclerosing agent (mean amount, 10.5 mL; range, 0.8-33.0 mL) was clearly visible with real-time MR monitoring. One patient developed a compartment syndrome, which was managed with surgery. No other complications were observed. VM volumes significantly decreased by 53% (range, 24%-86%; P = .02) 12 weeks after therapy. Nine of the 10 patients (90%) noted an improvement of symptoms. CONCLUSIONS In this limited preliminary series, 1.5-T MR imaging-guided percutaneous sclerotherapy for the treatment of VMs was feasible with a high degree of technical success, was relatively safe, and had a good therapeutic outcome after 1 year.
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Affiliation(s)
- Gustav Andreisek
- Institute for Diagnostic Radiology, University Hospital Zuerich, Raemistrasse 100, CH- 8091 Zürich, Switzerland.
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