1
|
Bhat A, Smart R, Egbert M, Susarla SM. Benign Non-Odontogenic Pathology in Children. Oral Maxillofac Surg Clin North Am 2024; 36:295-302. [PMID: 38402139 DOI: 10.1016/j.coms.2024.01.007] [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] [Indexed: 02/26/2024]
Abstract
This article provides a comprehensive overview of benign non-odontogenic pathologies. Bone-derived lesions like osteoma, osteoid osteoma, osteoblastoma, and osteochondroma are discussed in detail, emphasizing their radiographic features, locations, and treatment strategies. Cartilage-derived lesions such as chondroma, chondroblastoma, and chondromyxoid fibroma are also examined, noting their typical presentation and management approaches. The article then delves into fibroconnective tissue lesions. Mesenchymal and vascular lesions are detailed regarding their clinical and radiographic characteristics and treatment options. Lastly, nerve-derived lesions like schwannoma and neurofibroma are covered, providing insights into their association with diseases like neurofibromatosis and preferred management strategies.
Collapse
Affiliation(s)
- Aparna Bhat
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, 1959 NE Pacific Street, B-307, Seattle, WA 98195, USA
| | - Ryan Smart
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Private clinic 2585 23rd Avenue South, Fargo, ND 58103, USA.
| | - Mark Egbert
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, 1959 NE Pacific Street, B-307, Seattle, WA 98195, USA; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, 1959 Northeast Pacific Street, B-307, Seattle, WA 98195, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98015, USA
| | - Srinivas M Susarla
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, 1959 NE Pacific Street, B-307, Seattle, WA 98195, USA; Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, 1959 Northeast Pacific Street, B-307, Seattle, WA 98195, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98015, USA
| |
Collapse
|
2
|
Leyman B, Govaerts D, Dormaar JT, Meeus J, Bila M, Coropciuc R, Willaert R, Politis C. A 16-year retrospective study of vascular anomalies in the head and neck region. Head Face Med 2023; 19:32. [PMID: 37528467 PMCID: PMC10391867 DOI: 10.1186/s13005-023-00376-z] [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: 01/08/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
Depending on the diagnostic modality, the classification of vascular anomalies varies and so does the nomenclature. The 'International Society for the Study of Vascular Anomalies' (ISSVA) is the most widely accepted classification in the literature and is mainly based on the radiologic and clinical presentation. The aim of this article is to review the clinical practice of diagnosis and treatment of vascular anomalies in the head and neck region in a university hospital, with special focus on the nomenclature. All patients with a vascular anomaly presenting to the department of oral and maxillofacial surgery were reviewed in a retrospective manner. Nomenclature, diagnostic process, lesion characteristics, treatment and outcome were examined. The lesions were (re)classified according to the ISSVA classification. A total of 185 patients were identified, of which 12.4% (n = 23) had a congenital anomaly. After reclassification, the most common lesions were venous malformations (n = 47, 25.4%), followed by lobular capillary hemangiomas (n = 17, 9.2%). A group of 39 anomalies could not be further specified. One hundred and one patients (54,6%) received treatment, of which 93 were treated surgically (92,1% of treated patients). Endovascular treatment was considered in 41 patients but applied in only eight. This strict selection led to a low a complication rate. We provide an overview of the clinical practice in the management of vascular anomalies in a university hospital. The histology report is a source of miscommunication because clinicians use the ISSVA classification, while pathologists use the WHO classification. Every professional involved should be aware of the differences in classification and nomenclature.
Collapse
Affiliation(s)
- Bernard Leyman
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, Leuven, Belgium.
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium.
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
| | - Dries Govaerts
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Jakob Titiaan Dormaar
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
- Present Address: Radboudumc, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
| | - Jan Meeus
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Michel Bila
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Ruxandra Coropciuc
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Robin Willaert
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| |
Collapse
|
3
|
Geeurickx M, Labarque V. A narrative review of the role of sirolimus in the treatment of congenital vascular malformations. J Vasc Surg Venous Lymphat Disord 2021; 9:1321-1333. [PMID: 33737259 DOI: 10.1016/j.jvsv.2021.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/04/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Vascular malformations arise from defects in the morphologic development of the vascular system and can have an impact on quality of life and/or lead to severe complications. To date, vascular malformations are frequently managed by invasive techniques, after which recurrence is common. Sirolimus, a downstream inhibitor of the phosphatidylinositol 3 kinase/AKT pathway and best known for its immunosuppressive effect, has been used off-label for lesions for which approved therapies were associated with unsatisfactory results or recurrence. The aim of this study was to review the available data on the effect of sirolimus on the size and symptoms of different types of malformations and to summarize the main safety issues. METHODS A literature search in Pubmed, Embase, Web of Science, and SCOPUS was performed. Case reports, case series, and clinical trials evaluating the effect of sirolimus in vascular malformations were eligible for this review. Fully terminated studies published between January 2010 and May 2019 reporting an evaluable response on size and/or symptoms were included. Relevant data on lesion size, symptoms, side effects and duration of treatment were extracted as reported in the study. Additionally, we reported 10 unpublished cases who were treated in UZ Leuven. RESULTS The literature review included 68 articles, describing 324 patients. The median duration of therapy was 12 months (range, 1-60 months). After 6 months of treatment, the size of the malformation had at least decreased in 67% of patients with common venous malformations (VM), in 93% of patients with blue rubber bleb nevus syndrome and in all patients with verrucous VM. The size of lymphatic malformations improved in more than 80% of the patients, even in the case of extensive involvement such as in Gorham-Stout disease and generalized lymphatic anomaly. In addition, the majority of patients with syndromic vascular malformations experienced a decrease in size and reported symptoms improved in almost all patients, regardless of the type of malformation. Side effects were common (53%) but usually mild; mucositis and bone marrow suppression were the most common. Regrowth or recurrence of symptoms occurred in 49% of patients who discontinued treatment. Comparable effects were seen in our own patients. CONCLUSIONS This review shows that sirolimus is effective in decreasing the size and/or symptoms of particularly lymphatic malformations as well as VMs. Although common, side effects were usually mild. Nevertheless, clinical trials are needed to confirm the safety and effectivity of sirolimus and to identify the required serum levels and duration of treatment.
Collapse
Affiliation(s)
- Marlies Geeurickx
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Veerle Labarque
- Department of Pediatric Hemato-Oncology, University Hospitals Leuven, Leuven, Belgium; Catholic University Leuven, Center for Molecular and Vascular Biology, Leuven, Belgium.
| |
Collapse
|
4
|
Percutaneous MR-Guided Cryoablation of Low-Flow Vascular Malformation: Technical Feasibility, Safety and Clinical Efficacy. Cardiovasc Intervent Radiol 2020; 43:858-865. [PMID: 32236672 DOI: 10.1007/s00270-020-02455-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/12/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To retrospectively assess the technical feasibility, safety and clinical efficacy of percutaneous MR-guided cryoablation of low-flow vascular malformations (LFVM). MATERIALS AND METHODS Between July 2013 and May 2019, 9 consecutive patients (5 male; 4 female; mean age 39.4 ± 15.3 years, range 15-68) underwent MR-guided cryoablation of LFVM. Patients were treated due to pain in all cases. Procedural data, complications and clinical results were analyzed. RESULTS Technical success defined as complete coverage of the LFVM by the iceball without involvement of nearby non-target thermal-sensitive structures was achieved in 9/9 (100%) cases. Mean procedure time was 122 ± 20 min (range 90-150); 2-6 cryoprobes (mean 3.7 ± 1.2) and 2-4 freezing cycles (mean freezing time 19.8 ± 11.8 min; range 4-40) were applied. No complications were noted. Mean time from the first treatment to the last follow-up was 548 days (range 30-1776). Persistent/recurring pain was noted in 3/9 cases (33%) 30, 133 and 639 days after cryoablation, respectively, and was related in all cases to MR-confirmed local residual/recurring disease. A second cryoablation treatment was performed in these 3 cases with complete pain control at the last available follow-up (153, 25, 91 days, respectively). In the whole population, at mean 161 days (range 25-413) after the last treatment, on the numerical pain rate scale, pain significantly dropped from mean 6.4 ± 2.1 (range 3-9/10) before CA to mean 0.3 ± 0.9 (range 0-3/10) after (p = 0.009). CONCLUSIONS Percutaneous MR-guided cryoablation is technically feasible, safe and effective for the treatment of symptomatic LFVM. LEVEL OF EVIDENCE Level 3b, retrospective cohort study.
Collapse
|
5
|
Fábián Z, Szabó G, Petrovan C, Horváth KU, Babicsák B, Hüttl K, Németh Z, Bogdán S. Intraosseous venous malformation of the zygomatico-orbital complex. Case report and literature review with focus on confusions in vascular lesion terms. Oral Maxillofac Surg 2018; 22:241-247. [PMID: 29651653 DOI: 10.1007/s10006-018-0691-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
Abstract
Intraosseous vascular malformations (VascM) of the facial skeleton are rare entities, raising difficulties even today in their treatment. We present a case for zygomatic intraosseous venous malformation of traumatic etiology with growth dynamics presentation and a multidisciplinary treatment approach, with intravascular embolization surgical ablation and primary reconstructruction using a titanium patient-specific implant (PSI), and a review of the literature for intraosseous vascular lesions of the facial skeleton focusing on the diagnostic syntagms used by the involved medical personnel, to shed light on the confusions over these terms.
Collapse
Affiliation(s)
- Zoltán Fábián
- University of Medicine and Pharmacy, Târgu Mureș, Romania
| | - György Szabó
- Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Mária st. 52, Budapest, 1085, Hungary
| | - Cecilia Petrovan
- Department of Oral and Maxillofacial Surgery, County Clinical Emergency Hospital, 1 decembrie 1918 Blvd. 26-28, 540011, Târgu Mureș, Romania
| | - Karin Ursula Horváth
- Department of Ophthalmology, Mureș County Clinical Hospital, Márton Áron st. 26, 540058, Târgu Mureș, Romania
| | - Botond Babicsák
- Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Mária st. 52, Budapest, 1085, Hungary
| | - Kálmán Hüttl
- Heart and Vascular Center, Semmelweis University, Városmajor st. 68, Budapest, 1122, Hungary
| | - Zsolt Németh
- Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Mária st. 52, Budapest, 1085, Hungary
| | - Sándor Bogdán
- Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Mária st. 52, Budapest, 1085, Hungary.
| |
Collapse
|
6
|
Laviv A, Maly A, Abu-Tair J. Large facial lymphatic malformation treatment using sclerosing agent followed by surgical resection: clinical and pathology report. Oral Maxillofac Surg 2017; 21:363-369. [PMID: 28735345 DOI: 10.1007/s10006-017-0640-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/11/2017] [Indexed: 11/29/2022]
Abstract
Lymphatic malformations are rare slow-flow vascular malformations, with high tendency to appear in the head and neck region. The treatment of these lesions ranges from follow-up to sclerosing agent injection to surgical excision. The authors present a case of a new born with large extensive lingual and submandibular lymphatic malformation, for which the patient underwent tracheostomy and gastrostomy insertion. He was then treated successfully with sclerosing agent injections followed by surgical excision, with 7 years follow-up. The second case presented is a two and a half baby with large lingual lymphatic malformation, treated successfully with doxycycline injections followed by intraoral excision of the lesion. Pathology of the excised lesion is then demonstrated, which shows for the first time the different layers affected by the sclerosing agent.
Collapse
Affiliation(s)
- Amir Laviv
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Hebrew University-Hadassah School of Dental Medicine, PO Box 12272, 91120, Jerusalem, Israel.
| | - Alexander Maly
- Department of Pathology, Faculty of Medicine, Hebrew University-Hadassah, Jerusalem, Israel
| | - Jawad Abu-Tair
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Hebrew University-Hadassah School of Dental Medicine, PO Box 12272, 91120, Jerusalem, Israel
| |
Collapse
|
7
|
Martinez-Lopez A, Blasco-Morente G, Perez-Lopez I, Herrera-Garcia JD, Luque-Valenzuela M, Sanchez-Cano D, Lopez-Gutierrez JC, Ruiz-Villaverde R, Tercedor-Sanchez J. CLOVES syndrome: review of a PIK3CA-related overgrowth spectrum (PROS). Clin Genet 2016; 91:14-21. [PMID: 27426476 DOI: 10.1111/cge.12832] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 01/19/2023]
Abstract
Overgrowth syndromes are characterized by global or localized disproportionate growth associated with other anomalies, including vascular malformations and neurological and/or visceral disorders. CLOVES (Congenital Lipomatous asymmetric Overgrowth of the trunk with lymphatic, capillary, venous, and combined-type Vascular malformations, Epidermal naevi, Scoliosis/Skeletal and spinal anomalies) is an overgrowth syndrome caused by mosaic activating mutation in gene PIK3CA, which gives rise to abnormal PI3K-AKT-mTOR pathway activation. These mutations are responsible for the clinical manifestations of the syndrome, which include low- and high-flow vascular malformations, thoracic lipomatous hyperplasia, asymmetric growth, and visceral and neurological disorders. These common anomalies are illustrated with figures from two personal cases. Identification of the clinical and genetic characteristics of CLOVES syndrome is crucial for the differential diagnosis with other overgrowth syndromes, such as Proteus or Klippel-Trenaunay (K-T) syndromes, and for the therapeutic management of the different anomalies. In this context, a new entity comprising different syndromes with phenotypic mutations in PIK3CA has been proposed, designated PIK3CA-related overgrowth spectrum (PROS), with the aim of facilitating clinical management and establishing appropriate genetic study criteria.
Collapse
Affiliation(s)
- A Martinez-Lopez
- Dermatology Unit, Complejo Hospitalario Universitario, Granada, Spain
| | - G Blasco-Morente
- Dermatology Unit, Complejo Hospitalario Universitario, Granada, Spain
| | - I Perez-Lopez
- Dermatology Unit, Complejo Hospitalario Universitario, Granada, Spain
| | | | | | - D Sanchez-Cano
- Internal Medicine Unit, Complejo Hospitalario Universitario, Granada, Spain
| | | | - R Ruiz-Villaverde
- Dermatology Unit, Complejo Hospitalario Universitario, Granada, Spain
| | | |
Collapse
|