Vascular Anomalies of the Head and Neck: A Pediatric Overview

An Assessment of the Distribution and Prevalence of Benign Intraoral Pathologies

Objectives: The aim of this study is to evaluate the histopathological examinations of biopsy samples obtained from patients, and to determine the prevalence, age, and gender distribution of intraoral benign lesions. The study examines the distribution of all benign intraoral pathologies, including both soft tissue and hard tissue lesions, through which the goal is to contribute to clinical diagnostic processes. Methods: The histopathological evaluation results of 235 patients who underwent biopsy between 2021 and 2024 were retrospectively analyzed. Out of 235 patients, 123 (52.34%) were female and 112 (47.66%) were male. Lesions were categorized into two groups: soft tissue lesions and intraosseous lesions. The frequency, gender distribution, and age ranges of these lesions were assessed. Lesions exhibiting dysplasia or malignancy were excluded from the study. Results: The most common benign intraoral lesion was identified as the radicular cyst, observed in 69 patients. The age range for radicular cysts varied from 8 to 80 years, with 30 cases in females and 39 in males. The most frequently encountered soft tissue lesion was traumatic fibroma, which constituted 25.33% (19 patients) of all soft tissue lesions. Traumatic fibromas were observed in patients aged between 12 and 62 years. In terms of overall prevalence among all benign intraoral pathological lesions, radicular cysts ranked first (29.36%), followed by periapical granulomas (15.31%), dentigerous cysts (11.06%), and traumatic fibromas (8.08%). The occurrence of soft tissue lesions was significantly higher in females (66.66%) compared to males (33.34%). Conclusions: There are no recent studies in the literature evaluating the prevalence and demographic distribution of intraoral benign lesions. The most common lesions diagnosed in the study are typically associated with inflammation and irritation. The most common hard tissue lesion was the radicular cyst, which was seen across a wide age range and in similar proportions in men and women. Among soft tissue lesions, traumatic fibroma was the most common, particularly in women, and was seen across a wide age range. In terms of gender distribution, soft tissue lesions were twice as common in women as in men.

Combined Sclerotherapy With Surgical Resection in the Management of Oral Vascular Malformations: A Narrative Review With an Illustrative Two Case Series

Aim

To report a case series of two large VMs treated by sclerotherapy with further surgical resection for aesthetic purposes and discuss its outcomes.

Case Reports

Case 1: Six applications were performed with different volumes (1.5, 0.5, 0.5, 0.5, 0.5 and 0.5 mL, respectively) of Monoethanolamine Oleate (EO) in a VM lesion that affected the buccal mucosa and labial commissure (lesion size: 50 × 33.3 mm), associated with late surgical resection of exceeding cicatricial tissue in a 24‐year‐old female patient. Recurrence occurred after 120 days of follow‐up due to parafunctional suction. Case 2: three applications with different volumes of EO (1.0, 0.8 and 0.8 mL respectively) were performed in an upper lip VM lesion (lesion size: 30 × 40 mm) associated with late surgical resection and cheiloplasty in a 19‐year‐old male patient. Two months of follow‐up showed no signs of recurrence. At the present time, both patients are under observation.

Conclusion

Resolution of VMs can be achieved with different treatment options; especially in arteriovenous VMs, the definitive resolution it is challenging. Recurrence can happen if the main vessel was not achieved by sclerosing agent or if adjuvant parafunction is involved. VMs correct clinical diagnosis and classification is crucial in order to achieve optimal outcomes and prognosis.

[Management of pediatric vascular malformations]

BACKGROUND

Vascular malformations belong to the group of vascular anomalies. They are rare congenital diseases resulting from abnormal development of vessels and can arise in any location, often in the head and neck region. Clinical symptoms are variable, functional handicaps and esthetic problems may result.

MATERIALS AND METHODS

One differentiates between arteriovenous, lymphatic, venous, and capillary malformations and combinations thereof. Their classification, symptoms, diagnostics, and treatment options are discussed.

RESULTS

The different types of vascular malformations as well as their clinical presentation, diagnostic workup, and therapeutic options are presented, supported by clinical examples.

CONCLUSION

Interdisciplinary care of pediatric patients with vascular malformations is essential in order to generate a treatment concept after correct diagnosis and improve symptoms and quality of life.

New Insights into Cervicofacial Vascular Anomalies

Congenital cervicofacial vascular anomalies are extremely rare and present many difficulties in diagnosis and treatment requiring a multidisciplinary approach. Firstly, there is little consensus on this subject among head and neck specialists. There are two main types of vascular anomalies: vascular tumors and vascular malformations. Vascular malformations are also divided into malformations with slow blood flow (veins, lymphatics, capillaries or combined) and malformations with a fast blood flow (arteriovenous malformations and fistula). Vascular tumors like hemangiomas are known for their spontaneous involution with aging, while vascular malformations grow in dimensions with age. It is very important to choose the correct differential diagnosis between cervicofacial hemangiomas and vascular malformations for proper therapy management. Anamnesis and clinical exams help in raising suspicions about the real nature of a cervico-vascular anomaly. Furthermore, imaging brings in-depth details of the anomaly, ranging from ultrasound and contrast CT to MRI scanning and minimally invasive angiography. Angiography with selective embolization is rarely a curative procedure for arteriovenous malformations, being more suitable as a preliminary step before attempted surgical removal. Surgery is clearly necessary when there are aesthetic and functional deficits. Slow-flow vascular malformations present a reduced morbidity, and in cases without involution, the surgical ablation is reserved for the cases with aesthetic dysfunctions or psychological trauma. Lymphatic malformations must undergo surgical ablation when they are associated with mass effects and compression of great vessels or aerial viscera. The prognosis after surgical removal is good, with a low rate of recurrence or morbidity. Fast-flow vascular malformations require a combined approach, with embolization and excision in the next 48 h for safety reasons. Removal may be followed by reconstructive surgery depending on the location and dimensions of the malformation, with a possible secondary recovery of the normal microscopic vessels. Some of the masses may hinder the normal airflow and swallowing. Pathology is the gold standard for confirming the clinical and imaging diagnosis.

Adult-onset multifocal kaposiform hemangioendothelioma in the bone marrow, lung, liver, and brain: a case report

Kaposiform hemangioendothelioma (KHE), a rare form of vascular neoplasm, is typically seen in children. In this paper, we report a unique case of KHE replacing bone marrow tissue mimicking myeloproliferative neoplasm with additional involvement in the lung, liver, and brain in a 60-year-old Caucasian woman. The patient was initially seen in the hematology department for the chief complaint of epigastric pain and anemia. Abdominal magnetic resonance imaging (MRI) revealed mild splenomegaly with iron deposition secondary to extramedullary hematopoiesis. Additional workup was inconclusive. Subsequent bone marrow and lung biopsies eventually revealed bone marrow with extensive grade 3 fibrosis and multiple foci of low-grade vasoformative neoplasm in the lung suggestive of KHE. Although rare, KHE can present as an aggressive disease with indolent behavior in adults and can be distinguished from other vascular malignancies based on histopathology and imaging findings.

Birthmarks and birth defects in the head and neck region and claims of past-life memories: A systematic review

OBJECTIVE

This systematic review compiles published information on subjects with head or neck birth defects or birthmarks in which past-life memories were alleged.

DATA SOURCES

Electronic searches were done in April 2022 in the following bibliographic databases: MEDLINE/PubMed, Web of Science, Scopus, EMBASE, and PsycINFO.

STUDY SELECTION

References of the included studies and the gray literature were searched. Our sample included six studies reporting 19 cases of birthmarks and birth defects in the head and neck region with alleged past-life memories.

DATA EXTRACTION

The features of the lesions varied, and their size ranged between 0.5 to 12 cm. All the cases had interviews with the family of the deceased person and the family of the child with the birthmarks, and nine of them included some type of verified official report.

DATA SYNTHESIS

The strength of the evidence in the cases was analyzed using the strength-of-evidence scale.

CONCLUSION

This study showed that birthmarks and birth defects in the head and neck region occurred mostly in male children, with the possibility of these marks being caused by the fatal injury of the alleged personality. The literature lacks new cases with high strength of evidence, emphasizing the need for further primary studies.

Prevalence of oral and maxillofacial lesions in children and adolescents at a regional Brazilian oral pathology service: a retrospective study and the relevant literature review

PURPOSE

This study assessed the prevalence of maxillofacial lesions in children, i.e., 0-9 years, and adolescents, i.e., 10-19 years, in a Brazilian Oral Pathology Service and compared results with available literature.

METHODS

Clinical and histopathological records from January 2007 to August 2020 were analysed and a literature review investigating maxillofacial lesions in paediatric populations was also performed.

RESULTS

Overall, "reactive salivary gland lesions" and "reactive connective tissue lesions" were the most prevalent group of soft tissue lesions, affecting children and adolescents equally. From these, mucocele and pyogenic granuloma were the most prevalent histological diagnoses, respectively, regardless of age. These findings were consistent with the 32 studies included. Considering intraosseous lesions, "odontogenic cysts" and "periapical inflammatory lesions" were the most prevalent groups, with no relevant differences between age groups, except for the odontogenic keratocyst, which was more prevalent in adolescents. Moreover, several odontogenic tumours, such as ameloblastic fibroma and odontogenic myxoma, were significantly more prevalent in children.

CONCLUSION

Most maxillofacial lesions presented a similar prevalence between children and adolescents. Reactive salivary gland lesions and reactive connective tissue lesions were the prevailing diagnostic categories, regardless of age. Some odontogenic tumours and the odontogenic keratocyst showed significantly different frequencies across these age groups.

Targeted Diode Laser Therapy for Oral and Perioral Capillary-Venous Malformation in Pediatric Patients: A Prospective Study

BACKGROUND

This study describes the management protocol for capillary-venous malformations in pediatric patients and reports the epidemiology of diagnosed and treated cases at the Unit of Odontostomatology of the Aldo Moro University of Bari from 2014 to 2022.

METHODS

The authors classified the intraoral and perioral capillary-venous malformations by superficial diameter (<1 cm, 1-3 cm, >3 cm) and ultrasonographical depth extension (≤5 mm, >5 mm). All patients underwent pulsed-mode diode laser transmucosal photocoagulation (8-12 W/cm²); those with malformations that were wide (>3 cm) and deep (>5 mm) received intralesional photocoagulation, too (13 W/cm²). The children received general anesthesia based on their compliance and lesions' extension. The follow-up lasted six months.

RESULTS

A total of 22 females and 14 males (age range 4-18 years) presented 63 capillary-venous malformations. Five patients with Sturge-Weber syndrome, seven with hereditary hemorrhagic telangiectasia, and five with angiomatosis showed multiple malformations. The authors found no intraoperative or postoperative complications. Seventeen patients with lesions >1 cm and >5 mm deep required multiple laser sessions to heal.

CONCLUSION

The results of the current study support diode laser photocoagulation as the gold standard for the treatment of intraoral and perioral capillary-venous malformations in pediatric patients.

Serum Differentially Expressed Angiogenic Cytokines in Head and Neck Vascular Malformations

BACKGROUNDS

Head and neck vascular malformation (HNVM) is a highly complex congenital condition that is difficult to diagnose, monitor, and treat. Therefore, it is critical to explore serum cytokines that may be related to its pathology and prognosis.

METHODS

An antibody-based microarray was used to examine the expression of 31 angiogenic cytokines in 11 HNVM patients relative to 11 healthy subjects. ELISA was used to verify the results. We performed Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses of the differentially expressed cytokines (DECs). Additionally, we explored the function of DECs in human umbilical vein endothelial cells (HUVECs) in vitro via CCK-8, wound healing, transwell, and tube formation assays.

RESULTS

Expression of interleukin (IL)-10, matrix metallopeptidase-9 (MMP-9), and vascular endothelial growth factor receptor 2 (VEGF-R2) in HNVM patients was significantly higher, whereas levels of IL-12p40 and angiostatin were significantly lower in HNVM patients relative to healthy controls (P<0.05). However, ELISA only verified that IL-10, MMP-9, VEGF-R2, and IL-12p40 had significant expression changes. Functional enrichment analysis revealed DECs mainly participated in the RAS signalling pathway. Functional studies demonstrated that IL-10, MMP-9, and VEGF-R2 promote cell proliferation, migration, invasion, and tube formation, while IL-12p40 inhibited these processes in HUVECs.

CONCLUSIONS

The present study not only indicates that IL-10, MMP-9, VEGF-R2 and IL-12p40 may participate in the development of HNVMs but also provides a theoretical basis for the discovery of new targeted molecules in the treatment of HNVMs.