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Bhari N, Agarwal A, Asritha CVV, Panda M, Mahajan R. Vascular Malformations. Indian Dermatol Online J 2024; 15:415-430. [PMID: 38845674 PMCID: PMC11152494 DOI: 10.4103/idoj.idoj_633_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/19/2023] [Accepted: 12/24/2023] [Indexed: 06/09/2024] Open
Abstract
Vascular malformations are intricate anomalies of the circulatory system, presenting a diverse array of clinical manifestations, and posing significant challenges in diagnosis and treatment. The pathogenesis of vascular malformations is explored through the lens of genetic and molecular mechanisms, shedding light on the pivotal role of somatic mutations and dysregulated signaling pathways. Clinical presentations of vascular malformations are widely variable, ranging from cosmetic concerns to life-threatening complications. The utility of imaging techniques, such as magnetic resonance imaging (MRI), computed tomography (CT), and angiography, are discussed in detail, emphasizing their role in precise delineation and characterization. Therapeutic strategies for vascular malformations are multifaceted, considering factors such as lesion size, location, potential complications, and patient-specific factors. Traditional interventions, including surgical excision and embolization, are appraised alongside emerging approaches like targeted molecular therapies and minimally invasive procedures. The manuscript underscores the need for an individualized treatment approach, optimizing outcomes while minimizing risks and complications. In summation, this manuscript offers a comprehensive analysis of vascular malformations, encompassing their underlying pathogenesis, clinical nuances, diagnostic methods, and therapeutic considerations. By synthesizing current knowledge and highlighting gaps in understanding, this review serves as a valuable resource for clinicians, researchers, and medical practitioners, fostering an enhanced comprehension of vascular malformations and paving the way for improved patient care and innovative research endeavors.
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Affiliation(s)
- Neetu Bhari
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Akash Agarwal
- Department of Dermatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - C. V. V. Asritha
- Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Maitreyee Panda
- Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Rahul Mahajan
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Beqo BP, Gasparella P, Flucher C, Tschauner S, Brcic I, Haxhija EQ. Subcutaneous Granuloma Annulare vs. Subcutaneous Vascular Malformations in Children: A Diagnostic Challenge. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020362. [PMID: 36832491 PMCID: PMC9955411 DOI: 10.3390/children10020362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES There are various subcutaneous lesions in children and often there is difficulty in obtaining an accurate diagnosis by non-invasive diagnostic procedures. Subcutaneous granuloma annulare (SGA) is a rare granulomatous disease that, even after imaging, is often mistaken for a low-flow subcutaneous vascular malformation (SVM). This study aimed to accurately identify clinical and imaging clues to distinguish SGA from low-flow SVM. METHODS We retrospectively analyzed complete hospital records of all children with a confirmed diagnosis of SGA and low-flow SVM who underwent MR imaging at our institution from January 2001 to December 2020. Their disease history, clinical and imaging findings, management, and outcome were evaluated. RESULTS Among 57 patients with granuloma annulare, we identified 12 patients (nine girls) with a confirmed SGA diagnosis who underwent a preoperative MRI. Their median age was 3.25 years (range 2-5 years). Of 455 patients diagnosed with vascular malformations, 90 had malformations limited to the subcutaneous area. Among them only 47 patients with low-flow SVM were included in the study and further analyzed. Our SGA cohort had a female predilection (75%) and a short history of lump appearance of 1.5 months. SGA lesions were immobile and firm. Before MRI, patients underwent initial evaluation by ultrasound (100%) and X-ray (50%). Surgical tissue sampling was performed in all SGA patients to establish a diagnosis. All 47 patients with low-flow SVM were diagnosed correctly by MRI. A total of 45 patients (96%) underwent surgical resection of the SVM. A careful retrospective review of imaging findings of patients with SGA and SVM showed that SGA present as homogenous lesions in the shape of an epifascial cap with a typical broad fascial base extending towards the subdermal tissue in the middle of the lesion. In contrast, SVMs always present with variable-sized multicystic or tubular areas. CONCLUSIONS Our study shows clear clinical and imaging differences between low-flow SVMs and SGA. SGA presents characteristically in the shape of a homogenous "epifascial cap," which distinguishes these lesions from multicystic heterogenous SVMs.
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Affiliation(s)
- Besiana P. Beqo
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, A-8036 Graz, Austria
- Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Paolo Gasparella
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, A-8036 Graz, Austria
- VASCERN VASCA European Reference Centre, Bichat-Claude Bernard Hospital, 75018 Paris, France
| | - Christina Flucher
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, A-8036 Graz, Austria
- VASCERN VASCA European Reference Centre, Bichat-Claude Bernard Hospital, 75018 Paris, France
| | - Sebastian Tschauner
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, A-8036 Graz, Austria
| | - Iva Brcic
- Institute of Pathology, Medical University of Graz, A-8036 Graz, Austria
| | - Emir Q. Haxhija
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, A-8036 Graz, Austria
- Institute of Pathology, Medical University of Graz, A-8036 Graz, Austria
- Correspondence: ; Tel.: +43-(0)316-38513762; Fax: +43-(0)316-38513775
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Comparative Evaluation of Efficacy and Safety of the Diode Laser (980 nm) and Sclerotherapy in the Treatment of Oral Vascular Malformations. Int J Vasc Med 2022; 2022:2785859. [PMID: 36106096 PMCID: PMC9467756 DOI: 10.1155/2022/2785859] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background Vascular malformations are structural abnormalities which are formed by progressively enlarging aberrant and ecstatic vessels without endothelial cell proliferation and composed of the type of vessel involved, i.e., capillary, veins, and arteriovenous. Treatment of vascular malformations may involve many techniques like sclerotherapy, embolization, surgical resection, cryotherapy, laser treatment, or medical therapy. This observational prospective study is aimed at evaluating and comparing the effects and efficacy of diode laser and sclerotherapy in the treatment of oral vascular malformation. Materials and Methods 40 patients presenting with oral vascular malformation were included in the present study. The patients were divided equally (20 in each) into two groups, i.e., the laser group and sclerotherapy group. Sclerotherapy was performed with 3% sodium tetradecyl sulfate while the laser group was treated with diode laser 980 nm with transmucosal thermophotocoagulation. The patients were assessed for the response, remission, and side effects. The results obtained were tabulated and compared with the chi-square test. Results Side effects were found significantly lesser in the laser group compared to the sclerotherapy group (p < 0.05). Statistically significant difference was seen for postoperative pain between two groups. The laser group had mild to moderate pain compared to severe pain in the sclerotherapy group. Recurrence was observed more in the laser group compared to the sclerotherapy group. Conclusions Laser and sclerotherapy with 3% sodium tetradecyl sulfate both are effective in the treatment of vascular malformations. Diode laser seems to be better than sclerotherapy given lesser side effects and comfort to the patients while sclerotherapy seems to be better in respect to recurrences.
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4
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Pahl KS, Pabon-Ramos WM, Jeng MR. How we approach localized vascular anomalies. Pediatr Blood Cancer 2022; 69 Suppl 3:e29321. [PMID: 36070210 DOI: 10.1002/pbc.29321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 01/19/2023]
Abstract
Vascular anomalies are a group of disorders divided into two distinct subtypes: vascular tumors and vascular malformations. Vascular tumors are proliferative in nature, while malformations are nonproliferative. Simple, localized vascular malformations refer to a group of malformations that are localized to a single area of involvement. These simple malformations include capillary, lymphatic, venous, and arteriovenous malformations. The pediatric hematologists and oncologists are becoming increasingly involved in the diagnosis and management of these disorders. This review presents four cases as a means to discuss the diagnosis, clinical and imaging features, and management strategies of simple, localized vascular malformations.
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Affiliation(s)
- Kristy S Pahl
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Waleska M Pabon-Ramos
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael R Jeng
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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5
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Colletti G, Chiarini L. Lymphatic malformations do not regress spontaneously. J Pediatr Surg 2022; 57:1711. [PMID: 35414432 DOI: 10.1016/j.jpedsurg.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
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Palmar Venous Malformation: A Case Report of a Rare Occurrence and a Treatment Algorithm. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4270. [PMID: 35441065 PMCID: PMC9010119 DOI: 10.1097/gox.0000000000004270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
Abstract
Palmar venous malformations are not well described in the surgical literature and are a therapeutic challenge due to the intricate anatomy of the hand. We present the case of a 19-year-old right-handed female patient from Mexico who was referred to us with a right palmar lesion present since birth, previously diagnosed as a venous malformation. The patient reported that she had undergone sclerotherapy 10 years before in addition to a prior aborted attempt at excision. Venous palmar malformations are rare occurrences. Although an individualized approach is important, the development of an algorithm may assist in the standardization of the treatment of this pathology to preserve the hand’s functional status.
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Kostusiak M, Murugan S, Muir T. Bleomycin Electrosclerotherapy Treatment in the Management of Vascular Malformations. Dermatol Surg 2022; 48:67-71. [PMID: 34608081 DOI: 10.1097/dss.0000000000003220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intralesional injection of a sclerosing agent is a standard treatment for vascular malformations, but many repeat treatments are often required to achieve a response. The temporary application of an electrical field to the treated area increases cellular membrane permeability and therefore augments drug delivery. OBJECTIVE To report a case series of patients with vascular malformations who received bleomycin electrosclerotherapy (EST). MATERIALS AND METHODS A prospective observational case series of patients with vascular malformations treated with bleomycin EST. Only patients who did not respond or had limited response to standard sclerotherapy were included. The response to the treatment was assessed using a global assessment score and patient-reported outcome measures. RESULTS Thirty patients were treated with EST. Most of the patients had venous malformations (57%). Complete response or significant improvement was observed in 17 (57%) and 7 (23%) patients, respectively. Most of the patients were satisfied or very much satisfied with the outcome of the treatment. Most commonly reported complications were swelling, pain, and bleeding. CONCLUSION Electrosclerotherapy is a promising method of augmenting the efficacy of intralesional bleomycin injections when treating vascular malformations. It can potentially lead to a reduction in the administered dose and number of treatment sessions needed.
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Affiliation(s)
- Milosz Kostusiak
- All authors are affiliated with the Plastic Surgery Department, The James Cook University Hospital, Middlesbrough, United Kingdom
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8
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Abdel Razek AAK, Elmokadem AH, Soliman M, Mukherji SK. MR Imaging of Vascular Malformations and Tumors of Head and Neck. Magn Reson Imaging Clin N Am 2021; 30:199-213. [PMID: 34802579 DOI: 10.1016/j.mric.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Soft tissue vascular anomalies show a wide heterogeneity of clinical manifestations and imaging features. MR imaging has an important role in the diagnosis and management of vascular lesions of the head and neck. MR angiography is mandatory in cases of arteriovenous and combined malformations to assess the high-flow nature/component of the lesions and plan therapy. Infantile hemangiomas can be differentiated from congenital hemangiomas by clinical course. Reactive vascular tumors have nonspecific features similar to infantile hemangiomas. Locally malignant and malignant vascular tumors have irregular borders, infiltration of different tissue planes, and lower apparent diffusion coefficient values than benign vascular tumors.
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Affiliation(s)
| | - Ali H Elmokadem
- Department of Diagnostic Radiology, Mansoura University Faculty of Medicine, Elgomhoria Street, Mansoura 35512, Egypt
| | - Mosad Soliman
- Department of Vascular Surgery, Mansoura University Faculty of Medicine, Elgomhoria Street, Mansoura 35512, Egypt
| | - Suresh K Mukherji
- Marian University, Head and Neck Radiology, ProScan Imaging, Carmel, IN, USA.
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Song X, Li Z. Co-existing of craniofacial fibrous dysplasia and cerebrovascular diseases: a series of 22 cases and review of the literature. Orphanet J Rare Dis 2021; 16:471. [PMID: 34736485 PMCID: PMC8567608 DOI: 10.1186/s13023-021-02102-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 10/24/2021] [Indexed: 01/11/2023] Open
Abstract
Background Craniofacial fibrous dysplasia is a fairly rare condition. Some literature have reported a few patients with craniofacial fibrous dysplasia suffering from vascular abnormalities. This study aimed to describe the possible coexistence of craniofacial fibrous dysplasia and cerebrovascular diseases for the first time. Method We retrospectively reviewed the 1175 patients with craniofacial fibrous dysplasia in Beijing Tiantan Hospital and the information of the 22 patients coexisted with cerebrovascular diseases were described. In addition, we performed a systematic review for cases of craniofacial fibrous dysplasia with vascular abnormalities. Result 22 out of 1175 patients (1.9%) were diagnosed with craniofacial fibrous dysplasia and cerebrovascular diseases including 9 intracranial aneurysms, 4 venous malformations, 2 arteriovenous malformations, 1 moyamoya disease, 2 intracranial venous stenosis and 4 cerebral ischemia with a mean age of 38.18 years old. Only 2 patients were managed surgically for craniofacial fibrous dysplasia and 6 patients were treated with neurosurgery for cerebrovascular diseases. 8 patients were closely followed and only 1 patient’s symptoms worsened. Conclusion Craniofacial fibrous dysplasia might cause constriction of the intracranial vessels and alteration of the overall hemodynamics of the intracranial vasculature resulting in various cerebrovascular diseases. Multimodal screening and examinations seems reasonable for patients with craniofacial fibrous dysplasia for throughout treatment and prognosis evaluations.
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Affiliation(s)
- Xiaowen Song
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No 119, Nansihuan xilu, Beijing, 100070, China.,China National Research Center for Neurological Disease, Beijing, China
| | - Zhi Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No 119, Nansihuan xilu, Beijing, 100070, China. .,China National Research Center for Neurological Disease, Beijing, China.
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10
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Meirelles DP, do Couto AM, Silva LVO, Abreu LG, de Sousa SCOM, Custódio M, Tarquinio SBC, Batista AC, Mendonça EF, Libório-Kimura TN, Louredo BVR, Romañach MJ, de Andrade BAB, Nonaka CFW, Alves PM, de Sena LSB, Mesquita RA, de Aguiar MCF. Oral lymphatic malformations: A multicenter study of 208 cases and literature review. Head Neck 2021; 43:3562-3571. [PMID: 34517432 DOI: 10.1002/hed.26854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/24/2021] [Accepted: 08/24/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND To evaluate the frequency and analyze demographic and clinical characteristics of individuals with a histopathological diagnosis of oral lymphatic malformations (OLMs). METHODS A multicenter study was performed, collecting biopsy record data from a consortium of Brazilian Oral and Maxillofacial Pathology Centers. A review was also conducted to compare this data with cases already available in the literature. RESULTS This study retrieved 208 cases of OLM in the multicenter study and 1035 cases in the literature review. In both, OLMs affected male and female individuals equally, with the most affected site being the tongue. Individuals ≥60 years of age were uncommonly affected. Symptomatic and larger lesions were more commonly reported in the literature review. CONCLUSIONS This study comprises the largest sample of OLMs to date. OLMs are rare conditions, without sex predilection. The elderly proved to be less frequently affected, and the tongue is the most commonly affected site.
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Affiliation(s)
- Daniela P Meirelles
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Aline Maria do Couto
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Leni V O Silva
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lucas G Abreu
- Department of Child's and Adolescent's Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Suzana C O M de Sousa
- Division of Oral and Maxillofacial Pathology, Department of Stomatology, School of Dentistry, Universidade de São Paulo, São Paulo, Brazil
| | - Marcos Custódio
- Division of Oral and Maxillofacial Pathology, Department of Stomatology, School of Dentistry, Universidade de São Paulo, São Paulo, Brazil
| | - Sandra B C Tarquinio
- Department of Semiology and Clinics, School of Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Aline C Batista
- Department of Stomatology (Oral Pathology), School of Dentistry, Universidade Federal de Goiás, Goiânia, Brazil
| | - Elismauro F Mendonça
- Department of Stomatology (Oral Pathology), School of Dentistry, Universidade Federal de Goiás, Goiânia, Brazil
| | - Tatiana N Libório-Kimura
- Department of Pathology and Legal Medicine, School of Medicine, Universidade Federal do Amazonas, Manaus, Brazil
| | - Brendo V R Louredo
- Department of Pathology and Legal Medicine, School of Medicine, Universidade Federal do Amazonas, Manaus, Brazil
| | - Mário J Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno A B de Andrade
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cassiano F W Nonaka
- Department of Dentistry, School of Dentistry, Universidade Estadual da Paraíba, Campina Grande, Brazil
| | - Pollianna M Alves
- Department of Dentistry, School of Dentistry, Universidade Estadual da Paraíba, Campina Grande, Brazil
| | - Luana S B de Sena
- Department of Dentistry, School of Dentistry, Universidade Estadual da Paraíba, Campina Grande, Brazil
| | - Ricardo A Mesquita
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria C F de Aguiar
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Liu WP, Lu Y, Liu W. Gastrointestinal Bleeding Due to Arteriovenous Malformation of The Intestine. Am J Med Sci 2021; 362:e49-e50. [PMID: 34077705 DOI: 10.1016/j.amjms.2021.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/01/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Wei-Peng Liu
- Institute of Digestive Disease, China Three Gorges University, Yichang, China; Department of Gastrointestinal Surgery, Yichang Central People's Hospital, Yichang, China
| | - Yuan Lu
- Institute of Digestive Disease, China Three Gorges University, Yichang, China; Department of Gastrointestinal Surgery, Yichang Central People's Hospital, Yichang, China
| | - Wei Liu
- Institute of Digestive Disease, China Three Gorges University, Yichang, China; Department of Gastrointestinal Surgery, Yichang Central People's Hospital, Yichang, China.
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12
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Sivolella S, Sibillin M, Lupi A, Zanette G, Giraudo C. Diode laser for the treatment of a high flow lip vascular malformation: a case report with four years follow up. Minerva Dent Oral Sci 2021; 71:248-253. [PMID: 33929135 DOI: 10.23736/s2724-6329.21.04486-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND About 50% of vascular malformations are located at the head and neck region where they can usually be associated with functional and/or aesthetic limitations. Laser treatment has proven to be effective in treatment of small low-flow vascular malformations but little is known about the use of this therapy for high-flow larger arteriovenous malformations (AVMs). METHODS a congenital high-flow vascular malformation of the upper lip had to be treated because it was causing functional impairment and deformity which were affecting the quality of life. The mainstay of treatment is surgical therapy after embolization of the lesion but the treatment of high-flow lesions is difficult because of the high risk of mortality and morbidity. The lesion was then treated with transmucosal diode laser applications in multiple sessions. RESULTS The lesion progressively reduced in dimension without any sign of recurrence after multiple sessions of transmucosal diode laser applications. The clinical examination and the ultrasound scan performed four years after the last treatment demonstrated that no complications or further recurrence occurred. CONCLUSIONS multiple sessions of diode laser application can be a safe, effective and minimally invasive treatment for oral mucosa vascular malformations, even if characterized by high flow.
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Affiliation(s)
- Stefano Sivolella
- Dentistry Section, Department of Neurosciences, University of Padua, Padua, Italy
| | - Manuel Sibillin
- Dentistry Section, Department of Neurosciences, University of Padua, Padua, Italy -
| | - Amalia Lupi
- Radiology Institute, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Gastone Zanette
- Dentistry Section, Department of Neurosciences, University of Padua, Padua, Italy
| | - Chiara Giraudo
- Radiology Institute, Department of Medicine - DIMED, University of Padua, Padua, Italy
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13
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Colletti G, Chiarini L. A (Very) Brief History of the Nosography of Vascular Anomalies. J INVEST SURG 2021; 35:677-678. [PMID: 33719817 DOI: 10.1080/08941939.2021.1893414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Giacomo Colletti
- Department of Cranio-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Chiarini
- Department of Cranio-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, Modena, Italy
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14
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Chawla A, Gill S, Sharma S, Kumar V, Logani A. Endodontic implications of a patient with arteriovenous malformation: a case report and literature review. Int Endod J 2021; 54:975-987. [PMID: 33410128 DOI: 10.1111/iej.13473] [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: 04/24/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 11/29/2022]
Abstract
AIM To present the endodontic management of a patient diagnosed with a high-flow arteriovenous malformation (AVM) requiring root canal treatment and to discuss the relevant endodontic literature for this rare but significant problem. SUMMARY AVM is a complex communication of an artery and a vein in which the oxygenated blood is forced away from the intended tissue. The incidence of its occurrence in the face and neck is rare, and when present, the most common sign is gingival bleeding. Arteriovenous malformation is both a diagnostic and therapeutic challenge for dentists. Also, there is ambiguity regarding the precautions to be taken whilst doing endodontic procedures in such cases. Hence, there is a need to understand the disease process and its implications in order to prevent life-threatening complications during treatment. This case report highlights the successful endodontic management of a cariously exposed right maxillary second premolar in a patient diagnosed with high-flow AVM. On an orthopantomogram, the AVM was spreading in the left submandibular space involving the left ramus area. The clinical findings of limited mouth opening with inter-appointment swelling and trismus during treatment made the case unusual and challenging. This paper addresses the current understanding of the classification, diagnosis, clinical features and endodontic management, together with specific guidelines and recommendations whilst performing endodontic procedures in AVM cases. KEY LEARNING POINTS The classification and oral manifestations of AVM must be known and understood. Practitioners should be aware of the radiographic appearance of AVM. Recommended precautions should be taken when carrying out restorative and endodontic procedures in a patient with AVM. Antibiotic prophylaxis may be considered before endodontic treatment in a patient with AVM. Multidisciplinary treatment planning may be required.
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Affiliation(s)
- A Chawla
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - S Gill
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - S Sharma
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - V Kumar
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - A Logani
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Lymphangioma is a common type of congenital vascular disease in children with a broad spectrum of clinical manifestations. The current classification of lymphangioma by International Society for the Study of Vascular Anomalies is largely based on the clinical manifestations and complications and is not sufficient for selection of therapeutic strategies and prognosis prediction. The clinical management and outcome of lymphangioma largely depend on the clinical classification and the location of the disease, ranging from spontaneous regression with no treatment to severe sequelae even with comprehensive treatment. Recently, rapid progression has been made toward elucidating the molecular pathology of lymphangioma and the development of treatments. Several signaling pathways have been revealed to be involved in the progression and development of lymphangioma, and specific inhibitors targeting these pathways have been investigated for clinical applications and clinical trials. Some drugs already currently in clinical use for other diseases were found to be effective for lymphangioma, although the mechanisms underlying the anti-tumor effects remain unclear. Molecular classification based on molecular pathology and investigation of the molecular mechanisms of current clinical drugs is the next step toward developing more effective individualized treatment of children with lymphangioma with reduced side effects.
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Affiliation(s)
- Xiaowei Liu
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Division of Pediatric Oncology, Shanghai Institute of Pediatric Research, Shanghai, China
| | - Cheng Cheng
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Division of Pediatric Oncology, Shanghai Institute of Pediatric Research, Shanghai, China
| | - Kai Chen
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Division of Pediatric Oncology, Shanghai Institute of Pediatric Research, Shanghai, China
| | - Yeming Wu
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Division of Pediatric Oncology, Shanghai Institute of Pediatric Research, Shanghai, China.,Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, China
| | - Zhixiang Wu
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Division of Pediatric Oncology, Shanghai Institute of Pediatric Research, Shanghai, China.,Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, China
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16
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Rozell-Shannon L, Leahy J, Levitin GM, Nocini R, Colletti G. Assessing the impact of COVID-19 on individuals and families affected by vascular anomalies: The VBF COVID-19 survey. J Plast Reconstr Aesthet Surg 2020; 74:1101-1160. [PMID: 33342742 PMCID: PMC7832352 DOI: 10.1016/j.bjps.2020.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/01/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Riccardo Nocini
- Department of Otorhinolaryngogy, University Hospital of Verona Italy
| | - Giacomo Colletti
- Vascular Birthmarks Foundation (VBF), VBF Europe Co-Director; VBF Italy Medical Director (VBF Italy, Milan, Italy), VBF, Milan, Italy.
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17
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Liberale C, Rozell-Shannon L, Moneghini L, Nocini R, Tombris S, Colletti G. Stop Calling Me Cavernous Hemangioma! A Literature Review on Misdiagnosed Bony Vascular Anomalies. J INVEST SURG 2020; 35:141-150. [DOI: 10.1080/08941939.2020.1824041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | - Riccardo Nocini
- Department of Otorhinolaryngology, University Hospital of Verona, Verona, Italy
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18
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Usui H, Shinkai M, Kitagawa N, Mochizuki K, Kawakita I, Tsuzuki Y, Shinohara S, Yagi Y, Masuda M. Lymphatic malformations compromising the upper airway in children: ultrasound-guided intralesional focal sclerotherapy with bleomycin targeting culprit lesions. Pediatr Surg Int 2020; 36:1047-1054. [PMID: 32661596 DOI: 10.1007/s00383-020-04715-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Lymphatic malformations (LMs) compromising the upper airway is a life-threatening and intractable disease. Here, we establish a novel method to perform intralesional focal sclerotherapy targeting the culprit for airway stenosis. METHODS Between July 2015 and February 2020, 11 patients with airway-compromising LMs were enrolled. To yield maximal effects on the compromised airway with minimal adverse effects, ultrasound-guided intralesional bleomycin sclerotherapy assisted by balloon was performed, aimed at the most responsible lesion around the airway. A retrospective analysis was performed. RESULTS Ten patients presented with respiratory symptoms, eight of whom required airway support. The last asymptomatic patient showed airway compression on magnetic resonance imaging. The dose of bleomycin injected ranged from 1.3-9 mg per patient per course. A median of one course was required for withdrawal from airway support, and the median time was 15 days. A median of two courses was required to eliminate the lesion adjacent to the airway, which would have potential risk of airway stenosis. No complications were observed. CONCLUSIONS Our intralesional focal sclerotherapy technique with bleomycin targeting the culprit lesion is dose-sparing, safe, and effective in achieving rapid shrinkage of LMs compromising the upper airway in children, thereby avoiding tracheostomy.
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Affiliation(s)
- Hidehito Usui
- Department of Surgery, Kanagawa Children's Medical Center, 2-138-4, Mutsukawa, Minami-ku, Yokohama, 232-8555, Japan.
| | - Masato Shinkai
- Department of Surgery, Kanagawa Children's Medical Center, 2-138-4, Mutsukawa, Minami-ku, Yokohama, 232-8555, Japan
| | - Norihiko Kitagawa
- Department of Surgery, Kanagawa Children's Medical Center, 2-138-4, Mutsukawa, Minami-ku, Yokohama, 232-8555, Japan
| | - Kyoko Mochizuki
- Department of Surgery, Kanagawa Children's Medical Center, 2-138-4, Mutsukawa, Minami-ku, Yokohama, 232-8555, Japan
| | - Issei Kawakita
- Department of Surgery, Kanagawa Children's Medical Center, 2-138-4, Mutsukawa, Minami-ku, Yokohama, 232-8555, Japan
| | - Yukihiro Tsuzuki
- Department of Surgery, Kanagawa Children's Medical Center, 2-138-4, Mutsukawa, Minami-ku, Yokohama, 232-8555, Japan
| | - Shota Shinohara
- Department of Surgery, Kanagawa Children's Medical Center, 2-138-4, Mutsukawa, Minami-ku, Yokohama, 232-8555, Japan
| | - Yuma Yagi
- Department of Surgery, Kanagawa Children's Medical Center, 2-138-4, Mutsukawa, Minami-ku, Yokohama, 232-8555, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama, Japan
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Della Rosa N, Bertozzi N, Adani R. Vascular malformation and their unpredictable evolution: A true challenge for physicians. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020067. [PMID: 32921762 PMCID: PMC7716989 DOI: 10.23750/abm.v91i3.8298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 10/31/2019] [Indexed: 11/28/2022]
Abstract
Vascular anomalies are mainly divided into two groups: vasoproliferative/vascular neoplasms (e.g., hemangioma), and vascular malformations (VMs). The main difference between the two resides in the histopathological assessment, while vascular tumors are true neoplasm, typically congenital with rapid postnatal growth, and eventual slow regression; VMs have a single endothelial cell lining, tend to be regarded as acquired despite being congenital in nature, can undergo sudden and massive growth, miming neoplastic proliferation. Arteriovenous malformation (AVMs) are one type of fast flow VMs, with a four-stage natural history, and potentially disruptive evolution. Magnetic resonance is the gold-standard for diagnosis and pre-operative planning while computer tomography is particularly valuable for AVMs involving bones, and selective angiography can define source / draining vessels for sclerotherapy and surgical planning. Given their unpredictable evolution, AVMs shouldn’t be treated until symptomatic, complicated, or aesthetically unacceptable. Surgical resection should be preceded by arterial embolization from 24 to 72 hours, which must be extensive in order to reduce the risk of recurrence. Pain due to ischemic condition is one of the most common and debilitating symptoms of AVM, while gassosus gangrene is the most feared complication as they can become pabulum for bacteria overgrowth eventually resulting in necrotizing fasciitis. Given their clinical evolution, VMs pose physicians at great challenge in identifying the best-suited treatment for each case. It is of paramount importance to be able to make accurate diagnosis, understand the basic physiology, and use appropriate diagnostic and treatment modalities to optimize outcome. Proper multidisciplinary approach along with constant psychological support is the basis for a successful final outcome. Aim of this work was to provide a deeper insight into these relatively uncommon pathology and related hardship that afflicts both patients and their families. (www.actabiomedica.it)
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Affiliation(s)
| | - Nicolò Bertozzi
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy; Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy..
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20
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21
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Endoscopy-assisted, transoral submucosal coblation for pediatric retropharyngeal lymphatic malformations. Int J Pediatr Otorhinolaryngol 2020; 134:110074. [PMID: 32416530 DOI: 10.1016/j.ijporl.2020.110074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/25/2020] [Accepted: 04/26/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Retropharyngeal lymphatic malformations (LMs) are uncommon congenital anomalies. Open surgery, sclerotherapy and various pharmaceutical agents have been described to manage these lesions. However, when such lesions involve the retropharyngeal space with evidence of airway compromise, none of the above aforementioned modalities has shown superior result without repeated imaging and procedures. We describe the use of radiofrequency ablation (Coblation) in an endoscopic-assisted, transoral approach as a one-off treatment for pediatric retropharyngeal lymphatic malformations. METHODS Six patients with retropharyngeal lymphatic malformations, presented with airway compromise, were treated with endoscopic-assisted, transoral submucosal coblation in our unit between April 2015 to August 2018. We retrospectively reviewed their medical records, imaging and endoscopic findings. RESULTS Five out of our six patients had LMs involving only the retropharyngeal space, who received the coblation as their sole treatment. One patient with extensive LMs involving multiple neck compartments received coblation to the retropharyngeal part as an adjunct procedure. The average operation time was 62.8 min, and the average intraoperative blood loss was 3.8 ml. All patients were safely extubated immediately after the surgery. None required admission to pediatric intensive care unit (PICU), nor prolonged dysphagia reported. They were observed for 2-5 days post operatively. The average follow up was 28 months (1-5 years) and none required re-operation to date. CONCLUSIONS We presented our approach and outcome of 6 children with endoscopic-assisted, transoral submucosal coblation to retropharyngeal lymphatic malformation. We believe it is a safe and effective primary treatment to these patients, and a possible adjunct to complex vascular malformation involving multiple sites.
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Abstract
Recent advances in imaging have allowed a better understanding of imaging features and classification of vascular anomalies. This article focuses on imaging of vascular malformations; describes the updated classification system and clinical and imaging characteristics of the different subtypes; and discusses the associated syndromes, differential diagnosis, and available treatment options, including the role of imaging in management.
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23
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Ierardi AM, Colletti G, Biondetti P, Dessy M, Carrafiello G. Percutaneous sclerotherapy with gelified ethanol of low-flow vascular malformations of the head and neck region: preliminary results. ACTA ACUST UNITED AC 2020; 25:459-464. [PMID: 31650962 DOI: 10.5152/dir.2019.18542] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to evaluate the safety and effectiveness of percutaneous sclerotherapy using gelified ethanol in patients with low-flow malformations (LFMs). METHODS A retrospective study was performed, analyzing treatment and outcome data of 6 patients that presented with 7 LFMs (3 lymphatic and 3 venous). Median diameter of LFMs was 6 cm (interquartile range [IQR], 4.5-8.5 cm). Data regarding pain, functional and/or cosmetic issues were assessed. Diagnosis was performed clinically and confirmed by Doppler ultrasound, while extension of disease was assessed by magnetic resonance imaging (MRI). Percutaneous puncture was performed with 23G needle directly or with ultrasound guidance. All the LFMs were treated with gelified ethanol injection. The median volume injected per treatment session was 4.4 mL. RESULTS Technical and clinical success were obtained in all cases. No recurrences were recorded during a median follow up of 17 months (IQR, 12-19 months). Among the 6 patients, 5 had complete relief (83%) and one showed improvement of symptoms. The median VAS score was 7 (IQR, 6-7.5) before and 0 (IQR, 0-0) after treatment. All patients had functional and esthetic improvement (100%). Four patients (66.7%) revealed very good acceptance and two patients (33.3%) good acceptance. No major complications or systemic side effects were observed. CONCLUSION Gelified ethanol percutaneous sclerotherapy was easy to handle, well-tolerated, safe and effective in the short-term follow-up. Longer follow-up of efficacy is mandatory for further conclusions.
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Affiliation(s)
- Anna Maria Ierardi
- Department of Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan University, Milan, Italy
| | - Giacomo Colletti
- Department of Maxillofacial Surgery, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan University, Milan, Italy
| | - Pierpaolo Biondetti
- Department of Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan University, Milan, Italy
| | - Margherita Dessy
- Department of Maxillofacial Surgery, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan University, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan University, Milan, Italy
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The Use of a Three-Dimensional Printed Model for Surgical Excision of a Vascular Lesion in the Head and Neck. J Craniofac Surg 2020; 30:e566-e570. [PMID: 31188247 DOI: 10.1097/scs.0000000000005541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Facial vascular lesions are considered a great therapeutic challenge due to the considerable variability of clinical presentations. Surgical removal requires precise planning and advanced visualization to understand the three-dimensional anatomical relationships better.The aim of the study was to evaluate the feasibility of three-dimensional printed models, based on computed tomography angiography (CTA), in planning and guiding surgical excision of vascular lesions.A patient with a suspected vascular malformation in the face was recruited for participation in this feasibility study. Two personalized three-dimensional models were printed based off 2 separate CTA examinations. These constructs were used in preoperative planning and navigating surgical excision. The three-dimensional constructs identified the vicinity of the lesion and highlighted significant anatomical structures including the infraorbital nerve and vessels supplying the area of vascular anomaly. On postoperative follow-up the patient reported no recurrence of swelling and no sensory deficits.A personalized three-dimensional printed model of a facial vascular lesion was developed based on CTA images and used in preoperative planning and navigating surgical excision. It was most useful in establishing dangerous areas during the dissection process, including critical anatomical structures such as the infraorbital nerve. Combining conventional imaging techniques with three-dimensional printing may lead to improved diagnosis of vascular malformations and should be considered a useful adjunct to surgical management.
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Sircan-Kucuksayan A, Yaprak N, Derin AT, Ozbudak İH, Turhan M, Canpolat M. Noninvasive assessment of oral lesions using elastic light single-scattering spectroscopy: a pilot study. Eur Arch Otorhinolaryngol 2020; 277:1467-1472. [PMID: 32016524 DOI: 10.1007/s00405-020-05824-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: 09/26/2019] [Accepted: 01/22/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE In the present study, we investigated the potential application of elastic light single-scattering spectroscopy (ELSSS) as a noninvasive, adjunctive tool to differentiate between malignant and benign oral lesions in vivo. METHODS ELSSS spectra were acquired from 52 oral lesions of 47 patients prior to surgical biopsy using a single optical fiber probe. The sign of the spectral slope was used as a diagnostic parameter and was compared to the histopathology findings to obtain sensitivity and specificity of the ELSSS system in differentiating between benign and malignant tissues. RESULTS The sign of the spectral slope was positive for the benign tissues and negative for the malignant tissues. Nine malignant lesions and one high-grade dysplasia were correctly classified as cancerous. Six out of the ten low-grade dysplasia were correctly classified as cancerous, and four of them were misclassified as benign. Thirty benign lesions were correctly classified as benign, and two were misclassified as malignant. Our results indicate that the sign of the spectral slope enables the differentiation between malignant and benign oral lesions with a sensitivity of 80% and specificity of 94%. CONCLUSIONS ELSSS has the potential to be developed as an adjunctive screening tool in the noninvasive evaluation of oral lesions in vivo. This new diagnostic system may reduce the number of unnecessary biopsies.
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Affiliation(s)
| | - Neslihan Yaprak
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Akdeniz University, Dumlupınar Boulevard 07058 Campus, Antalya, Turkey.
| | - Alper Tunga Derin
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Akdeniz University, Dumlupınar Boulevard 07058 Campus, Antalya, Turkey
| | - İrem Hicran Ozbudak
- Department of Pathology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Murat Turhan
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Akdeniz University, Dumlupınar Boulevard 07058 Campus, Antalya, Turkey
| | - Murat Canpolat
- Department of Biophysics, School of Medicine, Akdeniz University, Antalya, Turkey
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26
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Guo L, Wu C, Li X, Song D, Sun J, Zhang Y. Simulated Angiography Using a Bleomycin Mixture for Sclerotherapy of Lymphatic Malformations. Front Pediatr 2020; 8:563517. [PMID: 33102408 PMCID: PMC7546802 DOI: 10.3389/fped.2020.563517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/19/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Repeat sclerotherapy of lymphatic malformations (LMs) is challenging. Accordingly, the aim of the present article is to describe a simulated angiography technique-a new method of bleomycin infusion for the treatment of LMs to achieve better outcome(s) in fewer sessions. Materials and Methods: A retrospective analysis of information housed in a prospectively collected LM database was performed. Patients with LM, revealed on imaging examination and treated using a simulated angiography technique with a bleomycin mixture, were included in the study. Visual evaluation and imaging examinations were performed to evaluate clinical improvement. Results: A total of 151 patients (82 male, 69 female; mean age, 28.29 months [range 1 month-12 years]) with LMs were included in this study. Excellent visual and radiological resolution was observed in 77% (117/151) of lesions, 17% (26/151) had significant improvement, and 8 patients exhibited a slight response. The number of procedures per patient varied from 1 to 5, and the average number of treatment sessions for LM was 1.34. Side effects included skin erythema at the injection site, local swelling, mild tenderness, and fever, which were controlled by oral antipyretics. No serious side effects were observed. Conclusions: Simulated angiography using a bleomycin mixture for sclerotherapy of LMs in children was feasible and demonstrated good effect with little trauma and less time per treatment.
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Affiliation(s)
- Lei Guo
- Department of Vascular Anomalies and Interventional Radiology, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Changhua Wu
- Department of Vascular Anomalies and Interventional Radiology, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Xiaoyan Li
- Department of Ultrasound, Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Dan Song
- Department of Vascular Anomalies and Interventional Radiology, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Jiali Sun
- Department of Vascular Anomalies and Interventional Radiology, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Yunkui Zhang
- Department of Vascular Anomalies and Interventional Radiology, Qilu Children's Hospital of Shandong University, Jinan, China
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27
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Manna S, Meyer A, Shigematsu T, Berenstein A, Courey M. Management of a Laryngeal Venous Malformation With Nd:YAG Laser and Bleomycin Sclerotherapy. Laryngoscope 2019; 130:2199-2201. [PMID: 31710699 DOI: 10.1002/lary.28392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022]
Abstract
Literature describing neodymium:yttrium-aluminum-garnet (Nd:YAG) photocoagulation and sclerotherapy for laryngeal venous malformations (VMs) is sparse. Here we present a case in which an extensive laryngeal VM in a 28-year-old female was managed through a combination of four serial Nd:YAG laser photocoagulation sessions and four bleomycin injections over the course of 2 years. The treatment plan resulted in resulted in noticeable lesion ablation, mucosalization, and significant improvement in symptoms. To our knowledge, this case is the first instance of bleomycin injection specifically into a laryngeal VM reported in the English medical literature. Laryngoscope, 130:2199-2201, 2020.
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Affiliation(s)
- Sayan Manna
- Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Annika Meyer
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Tomoyoshi Shigematsu
- Department of Interventional Neuroradiology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Alejandro Berenstein
- Department of Interventional Neuroradiology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Mark Courey
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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28
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Rodrigues G, Jayasankar B, Janumpalli KKR. Pyogenic Granuloma and Arteriovenous Malformation. Sultan Qaboos Univ Med J 2019; 19:e168-e169. [PMID: 31538020 PMCID: PMC6736270 DOI: 10.18295/squmj.2019.19.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/07/2019] [Accepted: 04/04/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Gabriel Rodrigues
- Department of General Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Balaji Jayasankar
- Department of General Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Krishna K R Janumpalli
- Department of General Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Samadi K, Salazar GM. Role of imaging in the diagnosis of vascular malformations vascular malformations. Cardiovasc Diagn Ther 2019; 9:S143-S151. [PMID: 31559160 DOI: 10.21037/cdt.2018.08.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Imaging evaluation of vascular malformations (VM) is paramount for proper diagnosis and treatment planning. These lesions often present as complex vascular masses with arterial, venous and lymphatic components, requiring the use of advanced imaging modalities for full anatomical characterization. Symptoms also depend of the location and flow characteristic of such lesions and range from: asymptomatic to severe forms of cardiac arteriovenous shunting. We present an overview of the diagnostic work-up of VM per most recent classification systems and describe imaging characteristics of such lesions at ultrasonography (US) and magnetic resonance imaging (MRI) as a diagnostic tool for work-up of such patients.
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Affiliation(s)
- Katayoun Samadi
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Gloria Maria Salazar
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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30
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Wang S, Du J, Liu Y, Zhang J, Ge W, Zhang Y, Guo Y, Li Y, Zhang X, Li X, Yu Y, Jin Y, He Y, Shi J, Tai J, Ni X. Clinical analysis of surgical treatment for head and neck lymphatic malformations in children: a series of 128 cases. Acta Otolaryngol 2019; 139:713-719. [PMID: 31169474 DOI: 10.1080/00016489.2019.1616818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Lymphatic malformations (LMs) are caused due to abnormal lymphatic development, and mainly occur in neonates or young children. At present, the role of surgery in the treatment of head and neck LMs is still controversial, focusing mainly on surgical efficacy and indications. Objective: This study aimed to explore the effect and influential factors of surgical treatment in children with head and neck LMs, hoping to provide a basis for rational selection of surgical indications. Methods: This retrospective study enrolled 128 children with head and neck LMs and underwent surgical treatment in Beijing Children's Hospital from May 2007 to June 2016. They were classified into three morphological groups: macrocystic, microcystic, and mixed. Based on de Serres staging, they were divided into five groups: stage I to V. The local lesion control rate, complication rate, and recurrence rate were summarized and analyzed. Results: The rate of completely controlled and almost completely controlled in cases with head and neck LMs was 71.1%. The postoperative complication rate was 13.3%, and the postoperative recurrence rate was 11.9%. Statistically significant difference was found for local lesion control and postoperative recurrence rates between different morphological and clinical staging groups. Furthermore, the complication rate showed a significant difference between different morphological groups, but not between clinical staging groups. Conclusions: Surgical resection in children with macrocystic, low-stage, or neck-limited LMs demonstrated better therapeutic effect, with fewer complications. However, the effect remained poor and had more complications for microcystic, diffused and high-stage patients. High stage and incomplete resection are considered as the main factors for postoperative recurrence. Current staging system for LMs has important predictive value in the prognosis of head and neck LMs. For LMs in posterior pharyngeal space, plasma ablation has certain advantages.
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Affiliation(s)
- Shengcai Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China
| | - Jiangnan Du
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China
| | - Yuanhu Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China
| | - Jie Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China
| | - Wentong Ge
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China
| | - Yamei Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China
| | - Yongli Guo
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China
| | - Yanzhen Li
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China
| | - Xuexi Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China
| | - Xiaodan Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China
| | - Yongbo Yu
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China
| | - Yaqiong Jin
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China
| | - Yuzhu He
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China
| | - Jin Shi
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China
| | - Jun Tai
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China
- Department of Scientific Research, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China
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Ghariani Fetoui N, Boussofara L, Gammoudi R, Belajouza C, Ghariani N, Denguezli M. Efficacy of sirolimus in the treatment of microcystic lymphatic malformation of the tongue. J Eur Acad Dermatol Venereol 2019; 33:e336-e337. [DOI: 10.1111/jdv.15628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- N. Ghariani Fetoui
- Department of Dermatology Farhat Hached University Hospital Sousse Tunisia
| | - L. Boussofara
- Department of Dermatology Farhat Hached University Hospital Sousse Tunisia
| | - R. Gammoudi
- Department of Dermatology Farhat Hached University Hospital Sousse Tunisia
| | - C. Belajouza
- Department of Dermatology Farhat Hached University Hospital Sousse Tunisia
| | - N. Ghariani
- Department of Dermatology Farhat Hached University Hospital Sousse Tunisia
| | - M. Denguezli
- Department of Dermatology Farhat Hached University Hospital Sousse Tunisia
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Abstract
OBJECTIVE Lymphatic malformations (LMs) are rare and benign diseases. This article aimed to present a series of surgically treated giant cervicofacial LMs in children. METHODS A retrospective analysis of giant cervicofacial LMs (tumor diameter greater than 10 cm) in children over the past 8 years was performed in our department. RESULTS The 10 patients included 4 males and 6 females. Macrocystic lesion presented in 4 patients, mixed cystic lesion presented in 4 patients, and microcystic lesion presented in 2 patients. All the patients underwent surgical resection combined with bleomycin sclerotherapy. Despite the wide range of lesions, most patients (7/10, 70%) received only a single treatment, 3 patients had a recurrent lesion. Seven patients experienced complete or almost complete resolution of the disease with an average follow-up time of 26.4 months. CONCLUSIONS Surgical resection is the preferred method for the treatment of giant LMs, combination of bleomycin sclerotherapy can reduce the recurrence rate. The curative effect of macrocystic disease is relatively enhanced compared with microcystic and mixed cystic diseases.
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Intramuscuar hemangiomas are venous malformations. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 120:89-90. [DOI: 10.1016/j.jormas.2018.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/30/2018] [Accepted: 11/18/2018] [Indexed: 11/18/2022]
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Kato CDNADO, Ribeiro MC, do Amaral MBF, Grossmann SDMC, de Aguiar MCF, Mesquita RA. Experience with 5% ethanolamine oleate for sclerotherapy of oral vascular anomalies: A cohort of 15 consecutive patients. J Craniomaxillofac Surg 2018; 47:106-111. [PMID: 30527382 DOI: 10.1016/j.jcms.2018.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/12/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To describe the effectiveness and safety of a sclerotherapy protocol with 5% ethanolamine oleate (EO) at 0.1 mL/3 mm for oral vascular anomalies (OVAs). Our hypothesis is that EO applied at a concentration of 5% may decrease the number of sessions necessary for clinical healing. MATERIALS AND METHODS We describe a cohort of 15 consecutive patients. OVAs <20 mm were included. Clinical data of the OVAs were collected. Descriptive and bivariate statistical analyses were performed. RESULTS Fifteen of the 19 OVAs were varicosities and the lower lip was the most affected site (n = 7). The median size was 6 mm, and one session was required in 89.5% of cases for clinical healing within 28 days. The pain/burning score was low (<2) for most lesions (63.1%) and the degree of satisfaction was high (>8) for all OVAs. The number of applications, final volume of drug and time to resolution differed significantly according to the size of the anomaly. CONCLUSION The protocol with 5% EO was shown to be effective and safe to treat OVAs <20 mm, and with a decrease in the number of sessions, volume and time to resolution, without complications and with high patient satisfaction.
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Affiliation(s)
| | - Michel Campos Ribeiro
- Department of Oral and Maxillofacial Surgery, Hospital Márcio Cunha, Ipatinga, Minas Gerais, Brazil
| | | | | | - Maria Cássia Ferreira de Aguiar
- Department of the Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ricardo Alves Mesquita
- Department of the Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Colletti G, Biglioli F, Poli T, Dessy M, Cucurullo M, Petrillo M, Tombris S, Waner M, Sesenna E. Vascular malformations of the orbit (lymphatic, venous, arteriovenous): Diagnosis, management and results. J Craniomaxillofac Surg 2018; 47:726-740. [PMID: 30770258 DOI: 10.1016/j.jcms.2018.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 08/02/2018] [Accepted: 09/10/2018] [Indexed: 11/27/2022] Open
Abstract
Vascular malformations are often found inside the orbit. Isolated venous malformations (frequently misnamed as cavernous hemangiomas) are the most frequent among these. However, also lymphatic and arteriovenous malformations can affect the orbit. The complex anatomy of the orbit and the fact that its content easily suffers from compartmental syndrome explain why treating orbital vascular malformations can be challenging and technically demanding. In this study, two institutions have retrospectively collected their cases, consisting in a total of 69 vascular malformations of the orbit. Each type of malformation has been evaluated separately in terms of diagnosis, indications for treatment, techniques and outcomes. Moreover, the authors have analyzed in detail venous malformations, identifying three different types, named orbital venous malformation (OVM) 1, 2 and 3. These behave differently from each other, and a prompt differential diagnosis is mandatory to pose correct indications, minimize risks and improve results. Overall, surgery was the technique of choice for OVM1, microcystic lymphatic malformations (LM) and arteriovenous malformations (AVM). A pure transnasal approach with mass removal and reconstruction of the medial wall with polyethylene sheets was chosen for OVM1 (intra- or extraconal) located in the medial or superomedial compartment. Sclerotherapy had a role in treating macrocystic LM and OVM3.
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Affiliation(s)
- Giacomo Colletti
- University of Milan, San Paolo Hospital, Department of Maxillo Facial Surgery (Head: Prof. Federico Biglioli), Italy.
| | - Federico Biglioli
- University of Milan, San Paolo Hospital, Department of Maxillo Facial Surgery (Head: Prof. Federico Biglioli), Italy
| | - Tito Poli
- University of Parma, Department of Maxillo Facial Surgery (Head: Prof. Enrico Sesenna), Italy
| | - Margherita Dessy
- University of Milan, San Paolo Hospital, Department of Maxillo Facial Surgery (Head: Prof. Federico Biglioli), Italy
| | - Marco Cucurullo
- University of Milan, San Paolo Hospital, Department of Maxillo Facial Surgery (Head: Prof. Federico Biglioli), Italy
| | - Mario Petrillo
- University of Milan, San Paolo Hospital, Department of Radiology (Head: Prof G.P. Carrafiello), Italy
| | | | - Milton Waner
- New York Vascular Birthmark Institute, United States
| | - Enrico Sesenna
- University of Parma, Department of Maxillo Facial Surgery (Head: Prof. Enrico Sesenna), Italy
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Dessy M, Giovanditto F, Cucurullo M, Dionisio A, Liberale C, Colletti G. About venous malformations of the facial bones. Oral Maxillofac Surg 2018; 22:345. [PMID: 29948284 DOI: 10.1007/s10006-018-0706-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/04/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Margherita Dessy
- Department of Maxillo Facial Surgery, University of Milan, via A. diRudini, 8, 20100, Milan, Italy
| | - Federica Giovanditto
- Department of Maxillo Facial Surgery, University of Milan, via A. diRudini, 8, 20100, Milan, Italy
| | - Marco Cucurullo
- Department of Maxillo Facial Surgery, University of Milan, via A. diRudini, 8, 20100, Milan, Italy
| | - Ambra Dionisio
- Department of Maxillo Facial Surgery, University of Milan, via A. diRudini, 8, 20100, Milan, Italy
| | - Carlotta Liberale
- Department of Maxillo Facial Surgery, University of Milan, via A. diRudini, 8, 20100, Milan, Italy
| | - Giacomo Colletti
- Department of Maxillo Facial Surgery, University of Milan, via A. diRudini, 8, 20100, Milan, Italy.
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Zhang B, Ma L. Updated classification and therapy of vascular malformations in pediatric patients. Pediatr Investig 2018; 2:119-123. [PMID: 32851245 PMCID: PMC7331351 DOI: 10.1002/ped4.12043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/13/2018] [Indexed: 12/12/2022] Open
Abstract
Vascular malformations (VMs) comprise a diverse group of diagnoses. They are classified by the type of vessel involved, including capillaries, veins, arteries, lymphatic vessels, or combinations of these. Complex VMs, although benign, can impair vital structures, cause deformations, or even threaten the child's life. Although multimodal treatment of VMs in children with disease include a wide variety of options such as observation, laser therapy, sclerotherapy, surgical resection, radiofrequency ablation, and medical therapy, the management of VMs necessitates a multifocal and multidisciplinary method with the patient's quality of life as the priority.
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Affiliation(s)
- Bin Zhang
- Department of DermatologyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Lin Ma
- Department of DermatologyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
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Affiliation(s)
- Tao Shi
- Department of Pathology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Li-Tian Wang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Gang Liu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
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Did Anton Raphael Mengs Suffer From a Vascular Malformation? J Craniofac Surg 2018; 29:1685. [PMID: 29570516 DOI: 10.1097/scs.0000000000004511] [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] Open
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Complications After Treatment of Head and Neck Venous Malformations With Sodium Tetradecyl Sulfate Foam. J Craniofac Surg 2018; 28:e388-e392. [PMID: 28328612 DOI: 10.1097/scs.0000000000003723] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate complications in patients with head and neck venous malformations (VMs) treated with foam sclerotherapy using sodium tetradecyl sulfate (STS). METHODS The authors retrospectively evaluated the complications, pain. and degree of satisfaction in 69 consecutive patients affected by cervicofacial VM managed with STS using the Tessari method in a single institution. RESULTS The average number of procedures for each patient was 2.1. The most frequent complication was blistering. We observed 1 patient of temporary weakness of a facial nerve branch, 1 paradoxical embolism, and 1 orbital compartment syndrome.The average pain score was 0 (no pain at all) (51.5%). There was no statistically significant correlation between patient satisfaction and the presence of complications or the degree of pain. CONCLUSIONS Sclerotherapy with STS is an effective treatment that yields to very high patient satisfaction. This procedure has an overall low complication rate and is usually effective within a few sessions. However, severe complications may occur; these must be pointed out in the informed consent and the surgeon must be aware of and ready to quickly treat them to prevent long-term sequelae.
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Ribeiro MC, de Mattos Camargo Grossmann S, do Amaral MBF, de Castro WH, Navarro TP, Procopio RJ, da Silva TA, de Nazaré Alves de Oliveira Kato C, Mesquita RA. Effectiveness and safety of foam sclerotherapy with 5% ethanolamine oleate in the treatment of low-flow venous malformations in the head and neck region: a case series. Int J Oral Maxillofac Surg 2018; 47:900-907. [PMID: 29329829 DOI: 10.1016/j.ijom.2017.12.004] [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: 07/10/2017] [Revised: 10/25/2017] [Accepted: 12/12/2017] [Indexed: 01/26/2023]
Abstract
The aim of this study was to evaluate the effectiveness and safety of 5% ethanolamine oleate (EO) foam in the treatment of low-flow venous malformations in the head and neck region. Seventeen consecutive patients (six male, 11 female) and 34 low-flow venous malformations were enrolled. The vascular anomalies ranged between 20mm and 80mm in size. The typical clinical indication was a swelling (88.2%) with a purple colour (85.3%); the most frequent location was the tongue (23.5%). Ethanolamine oleate foam was produced via the Tessari method and applied at 10mg per 1cm to the vascular anomalies. This process resulted in the highest clinical healing score in 64.7% of cases, and half of the patients reported a high level of satisfaction (score >9). In the majority of cases (88.2%), the patients reported that the pain immediately postoperative was mild or moderate. There were direct relationships between vascular anomaly size and the volume of EO applied, the number of sessions, and healing (P<0.05). No recurrence was observed during 6 months of follow-up. This case series showed the effectiveness and safety of 5% EO foam for the treatment of venous malformations in the head and neck region.
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Affiliation(s)
- M C Ribeiro
- Department of the Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - S de Mattos Camargo Grossmann
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Vale do Rio Verde Unincor, Belo Horizonte, Minas Gerais, Brazil
| | - M B F do Amaral
- Department of Oral and Maxillofacial Surgery, Baleia Hospital/CENTRARE, Belo Horizonte, Minas Gerais, Brazil
| | - W H de Castro
- Department of the Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - T P Navarro
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - R J Procopio
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - T A da Silva
- Department of the Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - C de Nazaré Alves de Oliveira Kato
- Department of the Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - R A Mesquita
- Department of the Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Bacci C, Sacchetto L, Zanette G, Sivolella S. Diode laser to treat small oral vascular malformations: A prospective case series study. Lasers Surg Med 2017; 50:111-116. [PMID: 28906568 DOI: 10.1002/lsm.22737] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The current work examined a consecutive series of patients presenting vascular malformations (VMs) and venous lakes (VLs) of the lip and oral mucosa who were treated with transmucosal diode laser applications and assessed over a 1 year period. STUDY DESIGN AND METHODS Fifty-nine patients (31 males and 28 females) presenting low-flow VMs or VLs of the oral cavity were treated transmucosally using a diode laser (with an 830 nm operating wavelength and 1.6 W output power) with a 320 µm diameter flexible fiber. All the lesions were assessed 7 days, 30 days, and 1 year after the laser treatment, and the lesion reduction percentage was scored on a one to five scale. The patients were also asked to assess their pain perception daily during the 7 days following the treatment using a visual analog scale (VAS). RESULTS There were no procedure-related intra- or post-operative complications; only modest pain intensity was reported. Thirty days after the treatment, lesion reduction was described as excellent or good in 52 cases; it was fair or poor in 7. Six patients (F:M ratio 2:4) required a second diode laser application. At the 1 year follow-up, volume reduction was complete in 48 out of 59 patients; there were five recurrences (F:M ratio 3:2). No relevant gender-related differences were noted. CONCLUSION The use of diode laser application to treat small oral VMs and VLs was associated to shorter operating times and fewer postoperative complications with respect to the scapel surgery approach. More than one session may nevertheless be required if the anomaly is larger than 10 mm. Lasers Surg. Med. 50:111-116, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Christian Bacci
- Department of Neurosciences, Dentistry Section, University of Padova, Via Giustiniani 2, 35131 Padova, Italy
| | - Luca Sacchetto
- Department of Neurosciences, Dentistry Section, University of Padova, Via Giustiniani 2, 35131 Padova, Italy
| | - Gastone Zanette
- Department of Neurosciences, Dentistry Section, University of Padova, Via Giustiniani 2, 35131 Padova, Italy
| | - Stefano Sivolella
- Department of Neurosciences, Dentistry Section, University of Padova, Via Giustiniani 2, 35131 Padova, Italy
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Abstract
Vascular anomalies present both a diagnostic and therapeutic challenge to physicians. Identification of these lesions is difficult due to their immense phenotypic variability, and naming conventions for vascular anomalies have historically been inconsistent. Terms such as "hemangioma" are informative when used correctly, but can cause confusion and miscommunication if applied indiscriminately to all vascular anomalies. Accuracy in classification is essential, as both disease course and therapeutic options differ greatly depending on the particular vascular anomaly present. In order for clinicians to properly diagnose and treat patients with these diseases, a unified nomenclature must be employed. This section provides an update on the current classification of vascular anomalies, with clinical descriptions of the most commonly encountered lesions, and clarifies the ambiguous nomenclature present in the existing literature.
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Affiliation(s)
- Jack E Steiner
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Beth A Drolet
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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Huang X, An J, Zhang Y, Cai Z. Intraosseous Venous Malformations of the Zygoma: Report of 4 Cases and Literature Review. Ann Otol Rhinol Laryngol 2017; 126:505-509. [PMID: 28376635 DOI: 10.1177/0003489417701934] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES As intraosseous venous malformations (IVMs) of the zygoma are very rare and clinical features are not typical, a correct preoperative diagnosis may be difficult to make. This study presents 4 cases of IVM of the zygoma and gives a review of their clinical manifestations, radiographic features, preoperative diagnosis, and differentials. METHODS The report of 4 cases was performed with an average 6-year follow-up. Medical records including clinical, radiographic, and histopathological information were reviewed. RESULTS All the patients were mid-aged women with a complaint of an enlarging mass over the midface. They all failed to receive a definite preoperative diagnosis, and the diagnoses of IVM in all patients were made via pathological evidence. Although they received different surgical treatments, all the follow-up results (2~12 years) were satisfactory. CONCLUSION Intraosseous venous malformations of the zygoma are benign lesions caused by abnormal vessel morphogenesis. Patients usually present in their 40s with a tender or painless swelling of the zygoma. The key to the diagnosis is the typical sunburst pattern of radiating trabeculae with intact cortices on computed tomographic scans. Intraosseous venous malformations should be differentiated from other lesions, including intraosseous meningioma, fibrous dysplasia, osteochondroma, osteosarcoma, and ossifying fibroma.
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Affiliation(s)
- Xiuling Huang
- 1 Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Jingang An
- 1 Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Yi Zhang
- 1 Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Zhigang Cai
- 1 Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R. China
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Stereophotogrammetric Evaluation of Labial Symmetry After Surgical Treatment of a Lymphatic Malformation. J Craniofac Surg 2017; 28:e355-e358. [PMID: 28230604 DOI: 10.1097/scs.0000000000003601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Lymphatic malformations (LMs) are rare, nonmalignant masses, frequently involving the head and neck, potentially causing impairment to the surrounding anatomical structures. Major LMs frequently cause facial disfigurement with obvious consequences on self-esteem and social functioning. The attempt to restore symmetry is thus one of the main goals of treatment. In this study, the authors present a not-invasive method to objectively quantify the symmetry of the labial area before and after surgical treatment of a LM, affecting a 16-year-old woman. This was done with sequential three-dimensional stereophotogrammetric imaging and morphometric measurements. The method showed a high reproducibility and supplied quantitative indicators of the local degree of symmetry, helping clinicians in its objective assessment, and facilitating treatment planning and evaluation. A quantitative appraisal of the results can additionally improve patient adherence to a usually multistage therapy.
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Fowell C, Verea Linares C, Jones R, Nishikawa H, Monaghan A. Venous malformations of the head and neck: current concepts in management. Br J Oral Maxillofac Surg 2016; 55:3-9. [PMID: 27894790 DOI: 10.1016/j.bjoms.2016.10.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/31/2016] [Indexed: 01/20/2023]
Abstract
Low-flow venous malformations are congenital lesions and they are the third most common vascular anomaly in the head and neck. In this paper, the third in a series of three educational reviews, we discuss current trends in their management, and include a summary of common sclerosant agents used in their control.
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Affiliation(s)
- C Fowell
- Consultant, Oral & Maxillofacial Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ.
| | - C Verea Linares
- Oral and Maxillofacial Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB
| | - R Jones
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB
| | - H Nishikawa
- Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH
| | - A Monaghan
- Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB
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48
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Huang Z, Zhang D, Chen Y, Wang Y, Chen W, Huang Z. Treatment of the recanalization of maxillary and mandibular arteriovenous malformations in children. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:530-536. [PMID: 27601351 DOI: 10.1016/j.oooo.2016.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 05/09/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study reviewed our experience in treating the recanalization of maxillary and mandibular arteriovenous malformations in children. STUDY DESIGN Four patients with maxillary or mandibular arteriovenous malformations (AVMs) were included in this study. All the patients had undergone multidisciplinary treatment of AVM at least 26 months before our review, including superselective intra-arterial embolization combined with bone wax packing. Computed tomographic angiography and digital subtraction angiography were performed to confirm the presence of recanalization. Superselective intra-arterial embolization combined with bone wax packing and tooth extractions were performed in the patients with recanalization. RESULTS After confirmation of the recanalization of AVM by digital subtraction angiography, the patients were treated with superselective intra-arterial embolization combined with bone wax packing and tooth extractions (if necessary). All the patients were followed up for 5 to 14 months, with an average of 9.5 months. The outcome for all patients was good, and no patient complained of pulsatile sensation or hemorrhage after treatment. CONCLUSIONS In the treatment for recanalization of maxillary and mandibular AVMs, reapplication of the superselective intra-arterial embolization, combined with bone wax packing, remains necessary.
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Affiliation(s)
- Zixian Huang
- Resident, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Daming Zhang
- Resident, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yaoting Chen
- Resident, Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Youyuan Wang
- Associate Professor, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Weiliang Chen
- Professor, Department Head, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhiquan Huang
- Associate Professor, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Gart L, Ferneini AM. Interventional Radiology and Bleeding Disorders: What the Oral and Maxillofacial Surgeon Needs to Know. Oral Maxillofac Surg Clin North Am 2016; 28:533-542. [PMID: 27624775 DOI: 10.1016/j.coms.2016.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Endovascular techniques are essential for controlling acute head and neck bleeding that cannot be controlled by local or systemic measures. Detailed knowledge of the head and neck vascular anatomy, advances in catheterization techniques, and the availability of new embolic materials have improved the safety, efficacy, and predictability of these procedures. To improve patient safety, the oral and maxillofacial surgeon must be familiar with these techniques.
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Affiliation(s)
- Laura Gart
- Division of Oral and Maxillofacial Surgery, Yale-New Haven Hospital, 333 Cedar St, New Haven, CT 06510, USA
| | - Antoine M Ferneini
- Private Practice, Connecticut Vascular Center, PC, 280 State St, North Haven, CT 06473, USA; Division of Vascular Surgery, Yale-New Haven Hospital/St. Raphael Campus, 1450 Chapel St, New Haven, CT, 06511, USA.
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50
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Intraneural Venous Malformations of the Median Nerve. Arch Plast Surg 2016; 43:371-3. [PMID: 27462571 PMCID: PMC4959981 DOI: 10.5999/aps.2016.43.4.371] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/10/2016] [Accepted: 04/27/2016] [Indexed: 11/21/2022] Open
Abstract
Venous malformations arising from the peripheral nerve are a rare type of vascular malformation. We present the first case of an intraneural venous malformation of the median nerve to be reported in a child and review the previous two cases of median nerve compression due to a venous malformation that have been reported. These cases presented with painless masses in the volar aspect of the wrist or with symptoms suggestive of carpal tunnel syndrome. Clinical suspicion should lead to the use of Doppler ultrasonography as the first-line diagnostic tool. Magnetic resonance imaging and histopathology can confirm the diagnosis, as phleboliths are pathognomonic of venous malformations. Surgical treatment appears to be the only modality capable of successfully controlling the growth of an intraneural malformation. Sclerotherapy and radiotherapy have never been used to treat this type of malformation.
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