Intratumoral ligation in the management of orofacial cavernous haemangiomas

Intratumoral ligation for the large venous malformation of the tongue

Intratumoral ligation is used to treat venous malformations; however, its clinical course and efficacy remain largely unknown. We report the case of a patient with a large venous malformation of the tongue who underwent successful intratumoral ligation. A 26-year-old woman presented to our clinic with a chief complaint of tongue swelling. Based on the results of imaging examinations and her medical history, a lingual venous malformation was diagnosed. The lesion was too large for surgical resection and the patient refused sclerosing therapy. We therefore carried out intratumoral ligation. The patient's postoperative course was uneventful, the lesion disappeared almost completely, and her tongue regained its normal shape and function. In conclusion, intratumoral ligation could be a useful technique for treating large orofacial venous malformations.

Hemostatic Net in Facelift Surgery: A 5-Year Single-Surgeon Experience

BACKGROUND

The hemostatic net has been promoted as a safe and effective method to prevent hematoma formation following facelift procedures. To date there is little published evidence to validate the replicability and effectiveness of the technique.

OBJECTIVES

This study presents 2 cohorts of facelift patients from a single surgeon's practice to assess the impact of the hemostatic net on hematoma formation.

METHODS

The records of 304 patients were reviewed on whom the hemostatic net was placed following a facelift between July 2017 and October 2022. Data were collected and assessed for complications and compared with a control group of 359 patients who underwent a facelift procedure without placement of a hemostatic net by the same surgeon between 1999 and 2004.

RESULTS

A total of 663 patients were included. In this retrospective cohort study, analysis of available data showed a significantly reduced hematoma rate of 0.6% in the intervention group compared with 3.9% in the control group (P = .006722).

CONCLUSIONS

The use of the hemostatic net is a safe, reproducible, and effective technique in reducing the risk of hematoma in facelift surgery.

LEVEL OF EVIDENCE: 4

Popescu Technique Revisited: Review of the Literature and Case Series

Management of vascular malformations depends on the size, type, age of the patient, location, dissemination, and depth of penetration. Treatment options include propranolol, which reduces endothelial vessel proliferation, minimally invasive sclerotherapy to induce fibrosis, or surgery. In 1985, Valerian Popescu described a new approach to treatment consisting of intratumoral ligation by compartmentalization. This technique allows for high doses of the sclerosant agent to be delivered as systemic dissemination is restricted by a series of strangulating suture loops that divide the mass into segments. We describe the management and outcome of 2 patients who presented with vascular malformations in the orofacial region and were managed using a Popescu suturing technique. Vascular obliteration was achieved by a series of strangulating suture loops placed percutaneously throughout each lesion using a curved needle with a resorbable material (Vicryl; Ethicon, Somerville, NJ). The aim was to segment the vascular malformation into manageable sections for subsequent injection of a sclerosant. The compartmentalization also ensured that the sclerosant stayed within these compartments and was not washed out into the general circulation. Good esthetic outcomes were achieved in very visible areas such as the commissure and the vermillion border. In these areas, a surgical resection would have certainly caused a disruption of the esthetics of the lips and, in the second case, probably an alteration of function. Intratumoral ligation can be used safely to achieve control of vascular malformations with good esthetic outcomes.

Cervicofacial hemangiomas: pattern, clinical management, and treatment outcomes

OBJECTIVE

The aim of this study was to evaluate treatment outcomes following various managements of hemangiomas.

STUDY DESIGN

Sixty-two patients were included and retrospective review conducted. Based on clinical management, each patient was assigned different treatment groups: steroid, sclerotherapy, surgical, and combined therapy. Treatment outcomes were evaluated based on improvement in size, color, and texture by a blinded panel of 4 raters including 3 doctors and 1 patient or patient's parents. Finally, comparison of outcomes between groups was analyzed.

RESULTS

The results revealed that there was reduction in size and improvement in color and texture following intervention in each group. No significant difference in outcome was observed between groups regarding change in size and texture. However, color change was better in combined and surgical treatment groups.

CONCLUSIONS

A favorable outcome can be achieved following appropriate intervention during all stages of development of hemangiomas.

Hot Hypertonic Saline and Compression Device: A Novel Approach in Preventing Severe Hemorrhage during Extirpation of Deep Vascular Malformations of the Face

BACKGROUND

Hemorrhage is a serious challenge in vascular malformations (VMs). This problem makes the surgical excision of the lesions difficult and sometimes impossible.

OBJECTIVE

The objective was to design a technique that will meet with the challenges of hemorrhage while performing surgery in such lesions in our environment.

PATIENTS AND METHODS

Seven patients with deep and moderately large VMs of the facial region were selected and treated with hot 7.5% hypertonic saline after compressing the feeder vessels. This was then complemented with surgical excisions.

RESULTS

There were successful surgical extirpations of the lesions without eventful hemorrhage.

CONCLUSION

Hot 7.5% hypertonic saline injected into VMs after emptying their hematic content caused sclerosis of the anomalous vessels. This made bleeding during surgery uneventful.

The role of imaging and surgery in the management of vascular tumors of the masseter muscle

PURPOSE

Intramuscular vascular malformations are uncommon lesions in the head and neck that may mimic salivary gland disease. This study reports on the use of various imaging modalities and recommends a surgical approach in the management of vascular malformations of the masseter muscle.

PATIENTS AND METHODS

This is a retrospective study of 7 consecutive patients with vascular tumors of the masseter muscle treated in one unit between 1995 and 2004. The age, gender, signs and symptoms, imaging methods, and surgical outcome are reported. A previously unreported surgical approach is described.

RESULTS

All patients had atypical swellings in and around the parotid region that were difficult to diagnose on plain radiography and computed tomography. Magnetic resonance imaging provides accurate three-dimensional images and provisional diagnosis of lesions within the masseter muscle. Six of the 7 patients underwent surgery by the recommended approach. No patients developed permanent facial weakness following modified parotidectomy. No recurrence of the vascular tumors occurred when the recommended approach is used.

CONCLUSIONS

Magnetic resonance imaging remains the imaging modality of choice for the management of tumors of the masseter muscle. The extended parotidectomy approach gives good and safe surgical access in the management of these uncommon lesions.

Acute exacerbation of macroglossia

We report the case of a large venous malformation of the tongue, preventing the patient from being able to contain it within the oral cavity. The extent of the malformation precluded a complete surgical excision. The immediate problems were; impending airway compromise, inability to speak, eat or drink, severe discomfort due to exposure-induced dryness and an embarrassing spectacle. This case demonstrates that even malformations considered to be incurable may be managed appropriately.

Tobacco-pouch suture technique for the treatment of vascular lesions of the lip in Enugu, Nigeria

We present the clinical findings and treatment of haemangiomas and arteriovenous malformations only, although many other vascular lesions affect the lip. We used simple clinical findings for our diagnosis and treated our patients by applying the Tabaksbeutelnaht (tobacco-pouch suture) technique to encircle the tumour and strangle it. Subsequently 10% saline (2-3 ml), which acted as a sclerosant, was injected into the tumour. Despite the absence of advanced imaging techniques and limited options for treatment, we achieved total success and good cosmetic results in 13 patients. This may be an effective therapeutic alternative to expensive methods used in developed countries and may be emulated by maxillofacial surgeons in poorer countries.

Surgery combined with copper wire implantation in the management of cavernous orofacial haemangiomas

This paper describes the management of a case of an extensive orofacial haemangioma by surgery combined with copper wire implantation. This technique of copper wire implantation in the management of orofacial haemangiomas was carried out for the first time in Jamaica by the authors. The use of percutaneous copper needles to induce therapeutic coagulation in cavernous haemangiomas, however, is not new, and this has been the basis of the use of copper wire.

Large arteriovenous malformations of the face: aesthetic results with recurrence control

Large facial arteriovenous malformations are problematic for patients because of grotesque disfigurement, risk of rapid enlargement, and life-threatening rupture. Successful treatment of these relentless complex lesions is one of the most difficult challenges facing plastic surgeons. From a series of 300 large facial arteriovenous malformations, 85 patients were treated with embolization and excision; six of these cases (representing six separate anatomic regions: labial, auricular, eyelid, cheek, chin, and occipitoparietal) were selected for review. The purpose of this article was to look critically at the management of these six facial arteriovenous malformations, including patient presentation, angiographic procedures, surgical planning and technique, and postoperative long-term follow-up care. Lessons learned from the six representative cases provide clues for the management of large facial arteriovenous malformations and demonstrate the possibilities of recurrence and their occasionally relentless behavior. The cases show that long-term control of these lesions with acceptable aesthetic results can be achieved. The mainstay of treatment includes the following: (1) selective intra-arterial embolization with fine catheters and direct lesional embolization; (2) judicious resection and reconstruction with local or expanded tissue flaps; and (3) careful follow-up with serial examinations, duplex, and arteriography.

Preliminary report: intratumoral ligation as a salvage procedure for the management of life-threatening arteriovenous malformations

Arteriovenous malformations are rare, high flow vascular anomalies which are frequently difficult to manage. Treatment options include embolisation and/or surgery, the latter ranging from proximal ligation (now discredited) through to radical resection. The Popescu technique of intratumoral ligation was used to treat 3 patients with massive, life-threatening arteriovenous malformations which were considered unsuitable for embolisation therapy or surgical resection. The main complications experienced were soft tissue swelling and necrosis, transient peripheral nerve entrapment and haemorrhage. The preliminary results have been encouraging and suggest that effective palliation and control can be achieved; 1 patient has no clinically demonstrable recurrence nearly 3 years after surgery.

Compression therapy for parotid haemangioma in infants. A report of three cases

Three cases of parotid haemangioma in infants are presented. Compression therapy was applied in these cases using a resin splint and a headcap and they were very effective. In the first case, the lesion had begun to reduce in volume within two weeks after starting the compression therapy. The haemangioma had disappeared completely in sixteen months. In the second and third cases, the lesions have disappeared in eight months and fifteen months, respectively. In all of the cases, no side effects were noticed. We believe that compression therapy is a safe and effective treatment modality for haemangiomas in infants even though these may disappear spontaneously in some cases.

Therapeutic arterial embolisation of vascular lesions in the maxillofacial region

The technique of therapeutic arterial embolisation involves the introduction of a thrombus-inducing material into the lumen of a blood vessel to occlude the vessel and reduce the blood supply to a lesion or to a specific part of the body. It is particularly useful in the maxillofacial region in the management of vascular lesions where marked diminution in blood flow can be achieved. This paper reviews the procedure and the materials for embolisation, and describes four patients for whom it was of considerable assistance.

Alveolar soft part sarcoma of the tongue

Alveolar soft part sarcoma (ASPS) is a rare malignancy; only 39 cases have been reported in the head and neck region. A 19-year-old woman is presented here who had ASPS of the tongue. Surgical resection was followed by irradiation therapy. She is tumor-free 2 years after treatment.