Ethanol sclerotherapy of head and neck venous malformations

Venous malformations

The often inexorable growth and expansion of congenital vascular malformations can result in substantial morbidity and, in some cases, premature death of these patients. Despite this, patients suffering from such lesions are often erroneously diagnosed and/or inadequately treated, due to a lack of expertise among primary care practitioners as well as specialists. Venous malformations are the most common type of congenital vascular malformations. Over the last two decades management of these lesions has significantly improved, predominantly due to the introduction and implementation of multidisciplinary team concept as well as improvement in diagnostic and treatment modalities. Relatively recently genetic studies are providing more insights into underlying pathophysiological mechanisms responsible for the development and progression of venous malformations and pharmacotherapy is becoming extensively evaluated for safety and efficacy in the treatment of these often challenging vascular lesions.

Adult Transglottic Haemangioma with Upper Airway Obstruction: Preservation of Airway and Voice

Adult laryngeal haemangioma is normally seen in the supraglottic or glottic region. Transglottic haemangioma is unusual, and treatment with primary endolaryngeal surgical excision may lead to undesirable bleeding and poor voice outcomes. A 25-year-old female presented with hoarseness and progressive upper airway obstruction symptoms. Videoendoscopy showed haemangioma involving all unilateral subunits of the larynx obstructing half of the subglottis. The transglottic haemangioma was treated with endolaryngeal ethanol injection with prior tracheostomy under local anaesthesia. Endolaryngeal laser surgery was performed later on to remove small residual haemangioma and granuloma. The haemangioma resolved; however, the ethanol injection to the paraglottic space results in vocal fold immobility but with favourable position and good muscle tone and bulk. The patient was successfully decannulated. Post-intervention subjective and objective voice assessments showed normal parameters except slight impairment of voice handicap index-10 with a total score of 12. Adult transglottic haemangioma can cause upper airway obstruction and requires intervention. Excision of the lesion endoscopically without sacrificing voice is achievable.

Potassium-Titanyl-Phosphate (KTP) Laser Photocoagulation Combined with Resection Using an Ultrasonic Scalpel for Pharyngolaryngeal Hemangioma via a Transoral Approach: Case Report and Literature Review

BACKGROUND Hemangiomas are relatively rare, slow-growing, benign neoplasms that can cause necrosis, ulceration, and infection leading to airway obstruction or intractable hemorrhage. Controversy persists regarding the treatment options for these tumors, which include active observation, corticosteroids, sclerotherapy, laser treatment, and surgical resection. CASE REPORT A 61-year-old man presented with a 6-month history of persistent throat clearing and foreign body sensation in the throat. He was receiving medical treatment and psychotherapy for major depressive disorder and anxiety disorder. Laryngoscopy and computed tomography revealed a large, irregular, lobulated mass covered by bluish mucosa in the hypopharynx and larynx on the right without involvement of the true vocal fold or subglottis. Orotracheal intubation was performed under general anesthesia. The hemangioma abutting the epiglottis and arytenoid was dissected by CO₂ laser. The hemangioma in the pharyngoepiglottic fold and aryepiglottic fold was resected using an ultrasonic scalpel. The hemangioma in the ventricle, false vocal fold, and paraglottic space was treated by potassium-titanyl-phosphate (KTP) laser photocoagulation. Pathological examination confirmed hemangioma. There has been no recurrence during 18 months of follow-up. CONCLUSIONS The treatment of pharyngolaryngeal hemangiomas is challenging. It is important to select treatment options considering the characteristics of the treatments and the anatomical and functional relationship between the hemangioma and the surrounding structures. Single-session KTP laser photocoagulation combined with surgical resection using an ultrasonic scalpel via a transoral approach according to anatomic site could be an effective treatment for pharyngolaryngeal hemangioma.

Therapeutic evaluation of sclerotherapy for limb venous malformations: A case series

OBJECTIVES

To examine three different methods for evaluating the effect of percutaneous sclerotherapy on limb venous malformations in a series of patients with a relatively long follow-up.

METHOD

The study was a retrospective study.

RESULTS

Thirty-eight patients treated with percutaneous sclerotherapy underwent sclerotherapy, with a median number of sessions of 4 (range, 1-10). They were followed up for 1-60 months (average 12.5 months). The kappa between clinical manifestations and Doppler ultrasound was 0.684 (P < 0.001). The kappa between clinical manifestations and magnetic resonance imaging was 0.217 (P = 0.006). The kappa between Doppler ultrasound and magnetic resonance imaging was 0.323 (P < 0.001). The rate of grade IV patients evaluated by clinical manifestations was significantly higher than that by Doppler ultrasound and magnetic resonance imaging.

CONCLUSIONS

Magnetic resonance imaging is the gold standard for VM imaging. Its consistency with clinical examination and Doppler ultrasound is poor, and Doppler ultrasound and clinical examination could be more appropriate for follow-up imaging after sclerotherapy.

Sclerotherapy for Venous Malformations of Head and Neck: Systematic Review and Meta-Analysis

We performed a systematic review and meta-analysis of studies performing sclerotherapy for treatment of venous malformations (VMs) of the face, head and neck. It is our hope that data from this study could be used to better inform providers and patients regarding the benefits and risks of percutaneous sclerotherapy for treatment of face, head and neck VMs. We searched PubMed, MEDLINE, and EMBASE from 2000–2018 for studies evaluating the safety and efficacy of percutaneous sclerotherapy of neck, face and head VMs. Two independent reviewers selected studies and abstracted data. The primary outcomes were complete and partial resolution of the VM. Data were analyzed using random-effects meta-analysis. Thirty-seven studies reporting on 2,067 patients were included. The overall rate of complete cure following percutaneous sclerotherapy with any agent was 64.7% (95% confidence interval [CI], 57.4–72.0%). Sodium tetradecyl sulfate had the lowest complete cure rate at 55.5% (95% CI, 36.1–74.9%) while pingyangmycin had the highest cure rate at 82.9% (95% CI, 71.1–94.7%). Overall patient satisfaction rates were 91.0% (95% CI, 86.1–95.9%). Overall quality of life improvement was 78.9% (95% CI, 67.0–90.8%). Overall permanent morbidity/mortality was 0.8% (95% CI, 0.3–1.3%) with no cases of mortality. Our systematic review and meta-analysis of 37 studies and over 2,000 patients found that percutaneous sclerotherapy is a very safe and effective treatment modality for treatment of VMs of the head, neck and face.

Sclerotherapy for Extensive Vascular Malformation in the Tongue

Vascular malformations (VMs) are benign lesions of blood vessels originated from an error in vascular morphogenesis during the embryologic phase. Generally, when located in the head and neck region VMs occurs in lips, tongue, buccal mucosa, gums, or palate. The VMs are usually asymptomatic, varies in size and may cause facial asymmetries. Different therapeutic modalities are available to treat VMs, which include surgical excision, cautery, cryotherapy, laser therapy, and sclerosing agents. The authors report 2 patients with extensive VM in the tongue treated with intralesional injection of a low-dose solution of monoethanolamine oleate (MO) and lidocaine. The first patient was a 69-year-old male patient and the 2nd a 65-year-old woman. In both patients, it were performed weekly application of 1:1 MO (Ethamolin) with Lidocaine (lidocaine 3% 1:50,000) in the amount of 0.1 mL of the solution per cm3 of lesion, with a total of 12 applications for each patient at the end of the treatment, with good results and without complications. It is important to be alert in which situation sclerotherapy should be used and that small doses of the sclerotherapeutic agent is essential for the prevention of complications after the procedure. Therefore, these patients showed that the sclerotherapy with MO may be an effective and simple treatment for extensive oral benign vascular lesions. In both patients, there was a great improvement in the clinical aspect of the lesions and patient's satisfaction.

Classification and treatment of orbital venous malformations: an updated review

Orbital venous malformation (OVM) is a congenital vascular disease. As a common type of vascular malformation in the orbit, OVM may result in vision deterioration and cosmetic defect. Classification of orbital vascular malformations, especially OVMs, is carried out on the basis of different categories, such as angiogenesis, hemodynamics, and locations. Management of OVM is complicated and challenging. Treatment approaches include sclerotherapy, laser therapy, embolization, surgical resection, and radiotherapy. A satisfactory outcome can be achieved only by selecting the appropriate treatment according to lesion characteristics and following the sequential multi-method treatment strategy. This article summarizes the current classification and treatment advances in OVM.

Balloon and Coil Occlusion of a Superior Sagittal Sinus Cortical Vein Facilitates Percutaneous Supraorbital Venous Malformation Sclerotherapy

Venous malformations are the most common of all vascular anomalies. Venous malformations are treated using a multidisciplinary approach with sclerotherapy representing the primary treatment modality. While rare, sclerotherapy in the central nervous system carries the risk of venous thrombosis, non-target embolization, and venous infarction and hemorrhage. Options for controlling venous outflow when treating venous malformations in the head and neck are limited. This report details the use of balloon and coil occlusion of a superior sagittal sinus cortical vein to facilitate percutaneous sclerotherapy of a supraorbital venous malformation.

Laparoscopic instrument use in laryngeal surgery: transoral resection of a supraglottic haemangioma

BACKGROUND

Adult laryngeal haemangiomas are rare vascular tumours that have been managed by a variety of surgical techniques.

METHODS

This paper describes a case of near-fatal acute airway obstruction secondary to such a lesion, followed by our approach to surgical resection using a laparoscopic bipolar tissue-sealing device.

RESULTS

This technique resulted in successful excision of the lesion, with no evidence of recurrence at one year of follow up.

CONCLUSION

Laparoscopic bipolar instruments can be used for the resection of moderate to large laryngeal haemangiomas as an alternative to laser excision.

Role of sclerotherapy in management of vascular malformation in the maxillofacial region: Our experience

The management of vascular anomalies is an extremely challenging area and is as divergent as the nature of lesions. Traditionally, embolization with the resection of the lesion has been used. The purpose of this report is to present cases treated successfully using sclerosing solution injections alone. Management of the vascular malformation using intralesional injections of sodium tetradecyl sulfate to the lesion is discussed. The procedure was performed two times at 2 weeks interval. Complete resolution of the lesion was found following sclerotherapy. Conservative interventional management using intralesional injection of sclerosing solution was successful in treating vascular anomaly.

Transoral robotic resection of an adult laryngeal haemangioma and review of the literature

Background:

Haemangioma of the adult larynx is an uncommon, benign lesion. The optimal surgical method of treating these lesions is controversial because only very limited case series are available. This paper reports the results of transoral robotic resection of a supraglottic haemangioma in an adult and reviews the literature.

Methods and results:

A 58-year-old woman presented having experienced a lump-in-the-throat sensation for 1 year. Investigations on laryngoscopy revealed a lobulated, dark red mass in the region of the supraglottis. This was successfully excised by transoral robotic excision without complications.

Conclusion:

Adult supraglottic haemangiomas can be treated successfully with transoral robotic excision; this potentially allows more of the surrounding mucosal tissue to be spared and enables easy control of bleeding.