Combined (team) approach to hemangioma management: arteriography with superselective embolization plus YAG laser/sapphire-tip resection

Arteriovenous malformation of nose-revision surgery

Areteriovenous malformations are rare in the head and neck region and generally arise from intracranial vessels. We present one rare case with spontaneous arteriovenous malformations related to the nose.

Treatment of hemorrhagic lymphatic malformation of the tongue with a pulsed-dye laser

Hemorrhagic lymphatic malformation (formerly called hemolymphangioma) of the tongue is an uncommon malformation that may pose both functional and cosmetic problems for the patient. The challenge has been to find a conservative treatment with low morbidity and better results than those achieved with surgical excision, which has been the mainstay of therapy. We report a case of successful treatment of a hemorrhagic lymphatic malformation of the tongue with a variable-pulse 595-nm pulsed-dye laser (Vbeam; Candela Corp, Wayland, Mass). In this patient, pulsed-dye laser treatment of the hemorrhagic lymphatic malformation achieved satisfactory functional and cosmetic outcomes. Its use in superficial vascular lesions of the mucosa should be considered.

Treatment of Facial Venous Malformations with Combined Radiofrequency Current and 900 nm Diode Laser

BACKGROUND

Laser treatment of venous malformations is a major challenge because of the large variations in skin pigmentation, anatomic location, and vessel size and depth.

OBJECTIVE

To determine the safety and effectiveness of electro-optical synergy, a new technology that combines the 900 nm diode laser with radiofrequency current for the treatment of facial venous malformation.

METHODS

Fourteen patients with Fitzpatrick skin types II to IV were treated for facial venous malformations with simultaneous radiofrequency energy (60-80 J/cm3) and optical diode laser energy (fluence 80-100 J/cm2) in one to three sessions. All lesions measured less than 100 cm2. Lesion clearance was evaluated by three specialists on the basis of digital photographs taken before the first treatment and 1 and 2 months after the last treatment.

RESULTS

Thirteen patients showed a complete response and one patient a partial response. The results were rated excellent in the 13 patients and good in one patient. Transient swelling, erythema, and pain were present in all patients, with permanent scarring in only one patient.

CONCLUSION

The combination of laser light and radiofrequency energy is effective and safe for the treatment of facial venous malformations. It provides additional heating of the vessels without increasing laser intensity. The side effects are minimal.

Transcatheter arterial embolization in the treatment of extensive maxillofacial hemangioma in children

Infantile hemangioma frequently occurs in the maxillofacial region as an extensive mass involving many vital structures. As such, many children are found to have an unresectable hemangioma at the initial diagnosis. In the present study transcatheter arterial embolization (TAE) alone or in combination with surgery and local injection of bleomycin A has been attempted to improve the treatment of these lesions. The results of evaluating the effectiveness and therapeutic role of TAE in these extensive maxillofacial hemangiomas in children are presented. We retrospectively analyzed the records of 17 children with maxillofacial hemangioma treated between 1997 and 2004. Altogether, 17 patients (11 boys, 6 girls) were diagnosed as having an extensive maxillofacial hemangioma based on its clinical manifestation, color Doppler ultrasonography, and sometimes computed tomography. They underwent selective TAE alone or TAE followed by surgical excision. For the children with Kasabach-Merritt syndrome, systemic corticosteroid therapy was administered first. All the children had an excellent response after TAE treatment without obvious complications, and the size of the hemangioma body markedly decreased. Local injection of bleomycin A was then undertaken in four children and surgical removal in five. All the children achieved successful disappearance of the hemangioma, with no recurrence during the follow-up period of 5 to 86 months. TAE is thus a reliable and effective therapeutic choice for extensive maxillofacial hemangioma in children, alone or as a preoperative adjunctive measure. It improves the feasibility of complete resection and effects the disappearance of these potentially dangerous bulky tumors with little bleeding and few complications.

Treatment of venous malformations with an intense pulsed light source (IPLS) technology: A retrospective study

BACKGROUND AND OBJECTIVE

The intense pulsed light source (IPLS) technology provides an innovative concept in the treatment of vascular lesions. We investigated the effectiveness of IPLS in the treatment of venous malformations.

STUDY DESIGN/MATERIALS AND METHODS

A retrospective study of 11 patients with venous malformations (VMA) treated with IPLS was initiated. Clinical VMA characteristics recorded were size and location. Data collected included treatment parameters (filters, pulse duration, fluence, and pulse sequencing), % clearance, and side effects (e.g., swelling, blisters, crusting, pain, altered pigmentation, and scarring).

RESULTS

Good and very good (70-100%) clearance was achieved in 8 malformations smaller than 100 cm(2). Especially small lesions needed only 2-3 treatments. Three VMA larger than 100 cm(2) could be cleared well in an average of 18 sessions. The most frequently used parameters were the 590 nm filter in long pulse mode, triple pulses, and fluences at an average of 80.4 J/cm(2). Side effects included prolonged erythema in 23.6, swelling in 17.9%, crusting in 4.7%. Bleeding, hypo-, hyperpigmentation, and scarring were rare (0.9% respectively).

CONCLUSION

IPLS presents an effective method for treating VMA, especially small malformations, with a justifiable rate of side effects when optimal parameters are chosen.

Extensive facial vascular malformations and haemangiomas: a review of the literature and case reports

We present 6 selected cases of extensive facial vascular anomalies extending to the skull base or actually involving it. These patients are compared with other cases in the literature. The spontaneous course of these vascular lesions is different and so variable treatment modalities are suggested depending on the age of the patient and the type of lesion. In young children, haemangiomas are common and spontaneous involution is characteristic. Conservative treatment in the sense of a wait-and-see approach is thereby favoured if there is no urgent indication such as involvement of essential structures, e.g. blockage of an orifice as demonstrated in one case or complications such as excessive bleeding. Vascular malformations most commonly appear in adults, there is no tendency to spontaneous involution and resection is usually necessary, especially in arteriovenous malformations. Nowadays, preoperative superselective embolization is recommended to minimize intraoperative blood loss. Superselective embolization is the treatment of choice in cases of a-v fistulae. Proximal ligation of the supplying arteries should be avoided because this may make embolization more difficult, and may be responsible for the common occurrence of rapid revascularization.

YAG laser meloplasty and blepharoplasty

Twenty-eight patients have undergone facelift and blepharoplasty in which the YAG laser scalpel was used. The laser is able to produce an incision with excellent hemostasis. The patients in this series demonstrated markedly diminished blood loss during surgery and reduced bruising, swelling, pain, and discomfort postoperatively. Contralateral procedures done with the laser on one side and conventional surgery on the other side demonstrated greater benefit on the laser side.

Pulsed dye laser therapy for infants and children

Pulsed dye laser therapy has revolutionized the treatment of benign vascular neoplasms of the skin. Treatment is safe and generally effective in children of all ages. Because of the pain associated with the treatment, special techniques are discussed that may minimize the physical and psychological traumas associated with treatment.

Pediatric interventional radiology: current practice and innovations

The purpose of this article is to provide an update of pediatric interventional procedures for the interventionalist, and especially for those who treat children infrequently. Most pediatric interventional procedures are modifications of techniques devised for adults, in that some are unique to pediatrics. These are stressed in the presentation.

Feasibility of skin deepithelialization using the contact neodymium-yttrium-aluminum-garnet laser

In a manner similar to laserbrasion, the carbon dioxide (CO2) laser has a proven role for expediting skin deepithelialization, which is an essential component of many reconstructive procedures. However, the contact Neodymium-Yttrium-Aluminum-Garnet (Nd:YAG) laser has many additional attributes such as tactile feedback and less plume that theoretically offer an advantage over the CO2 laser for this adjunctive maneuver. In rat experimental models and clinical applications, removal of the epidermis necessary for skin deepithelialization may indeed be achieved using a rounded probe for vaporization with the contact Nd:YAG laser. Unfortunately, the length of time necessary for skin deepithelialization with the Nd:YAG laser exceeded even conventional methods, such that this role with the present technology, although possible, is inefficient and impractical.