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Extracranial vascular malformations (hemangiomas and vascular malformations) in children and adolescents - diagnosis, clinic, and therapy.

Eivazi B, Werner JA - GMS Curr Top Otorhinolaryngol Head Neck Surg (2014)

Bottom Line: The options for the treatment of venous malformations could be significantly improved during the last years.Today the treatment with dye laser is the preferred therapy for capillary malformations and it is superior to other therapeutic options as for example photodynamic therapy.Frequently they are compared to malignant head and neck tumors, in particular when a curative treatment can no longer be assured because of diffuse or multifocal extent and when the disease shows a progressive course.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otolaryngology, Head & Neck Surgery, Philipps University of Marburg, Angioma Center Marburg, Germany.

ABSTRACT
The field of extracranial vascular anomalies is considered as special focus of pediatric otolaryngology and it has shown a rapid development during the last years. The reason for this interest is finally also due to the global acceptance of the classification introduced by the ISSVA (International Society for the Study of Vascular Anomalies). Hemangiomas are the most frequently observed vascular tumors. Today the systemic propranolol therapy is mostly used for therapy of hemangiomas requiring treatment. Increasingly, the topical application of beta blocker is discussed while the benefit in the head and neck seems to be limited. Vascular malformations are classified according to the morphology of the affected part of the vascular system in arterial, venous, arterio-venous, lymphatic, capillary, and combined vascular malformations. Conventional surgery, sclerosing therapy, and laser treatment are invasive options for the treatment of lymphatic malformations. The options for the treatment of venous malformations could be significantly improved during the last years. In this context, the use of Nd:YAG laser, the conservative treatment of the localized disseminated intravascular coagulation with low-molecular weight heparin, the re-discovery of bleomycin as effective sclerosing agent, and the improvement of alcohol-based embolization agents must be mentioned. Today the treatment with dye laser is the preferred therapy for capillary malformations and it is superior to other therapeutic options as for example photodynamic therapy. Arterio-venous malformations as representatives for high-flow lesions are the high-risk lesions. Frequently they are compared to malignant head and neck tumors, in particular when a curative treatment can no longer be assured because of diffuse or multifocal extent and when the disease shows a progressive course. The combined treatment of embolization and surgical resection and if necessary consecutive defect reconstruction have turned out to be appropriate for arterio-venous malformations. Incurable findings are still a major challenge. Despite the introduction of antiangiogenetic drugs in oncology, the medicamentous therapeutic approach could not be established for arterio-venous malformations up to now.

No MeSH data available.


Related in: MedlinePlus

Venous malformation in the area of the buccal soft parts in a 14-year-old patient. (a) Preoperative findings of MRI and (b) specimen of a complete extirpation via an enoral approach.
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Figure 10: Venous malformation in the area of the buccal soft parts in a 14-year-old patient. (a) Preoperative findings of MRI and (b) specimen of a complete extirpation via an enoral approach.

Mentions: Especially for venous malformations, the therapeutic possibilities could be optimized during the last years. Regarding the manifestations in the head and neck area, pathophysiological knowledge could be included in the treatment planning. Conventional surgical approaches to advanced venous malformations are potentially threatening and associated with a high risk of bleeding and postoperative morbidity. With this background, the increasing distribution of laser treatments has gained an important value for venous malformations. The Nd:YAG laser system which has been applied in otolaryngology for more than twenty years now has turned out to be a reliable instrument for the treatment of venous malformations in the area of the mucosa [32] (Figure 9 (Fig. 9)). Long-term results of Nd:YAG laser application for the treatment of venous malformations of the upper aerodigestive tract show a nearly negligible incidence of complications. Especially bleedings that are otherwise associated with conventional surgical techniques rarely occur during laser treatment. However, this does not mean that conventional surgery has lost its significance for the treatment of venous malformations. Regarding the involvement of cervical or facial soft tissue, the laser application is clearly limited. A conventional surgery can then be recommended when extended venous malformations of the parotid region or in the area of the deep cervical and facial soft tissue must be treated (Figure 10 (Fig. 10)). In addition of high surgical expertise open surgery requires extra efforts due to the use of additional instruments to increase the treatment safety. Beside transoesophageal echocardiography for prophylactic detection of possible air embolism, autologous blood transfusion systems to avoid life-threatening bleedings are meanwhile standard in the operating room for the treatment of extended venous malformations.


Extracranial vascular malformations (hemangiomas and vascular malformations) in children and adolescents - diagnosis, clinic, and therapy.

Eivazi B, Werner JA - GMS Curr Top Otorhinolaryngol Head Neck Surg (2014)

Venous malformation in the area of the buccal soft parts in a 14-year-old patient. (a) Preoperative findings of MRI and (b) specimen of a complete extirpation via an enoral approach.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4273163&req=5

Figure 10: Venous malformation in the area of the buccal soft parts in a 14-year-old patient. (a) Preoperative findings of MRI and (b) specimen of a complete extirpation via an enoral approach.
Mentions: Especially for venous malformations, the therapeutic possibilities could be optimized during the last years. Regarding the manifestations in the head and neck area, pathophysiological knowledge could be included in the treatment planning. Conventional surgical approaches to advanced venous malformations are potentially threatening and associated with a high risk of bleeding and postoperative morbidity. With this background, the increasing distribution of laser treatments has gained an important value for venous malformations. The Nd:YAG laser system which has been applied in otolaryngology for more than twenty years now has turned out to be a reliable instrument for the treatment of venous malformations in the area of the mucosa [32] (Figure 9 (Fig. 9)). Long-term results of Nd:YAG laser application for the treatment of venous malformations of the upper aerodigestive tract show a nearly negligible incidence of complications. Especially bleedings that are otherwise associated with conventional surgical techniques rarely occur during laser treatment. However, this does not mean that conventional surgery has lost its significance for the treatment of venous malformations. Regarding the involvement of cervical or facial soft tissue, the laser application is clearly limited. A conventional surgery can then be recommended when extended venous malformations of the parotid region or in the area of the deep cervical and facial soft tissue must be treated (Figure 10 (Fig. 10)). In addition of high surgical expertise open surgery requires extra efforts due to the use of additional instruments to increase the treatment safety. Beside transoesophageal echocardiography for prophylactic detection of possible air embolism, autologous blood transfusion systems to avoid life-threatening bleedings are meanwhile standard in the operating room for the treatment of extended venous malformations.

Bottom Line: The options for the treatment of venous malformations could be significantly improved during the last years.Today the treatment with dye laser is the preferred therapy for capillary malformations and it is superior to other therapeutic options as for example photodynamic therapy.Frequently they are compared to malignant head and neck tumors, in particular when a curative treatment can no longer be assured because of diffuse or multifocal extent and when the disease shows a progressive course.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otolaryngology, Head & Neck Surgery, Philipps University of Marburg, Angioma Center Marburg, Germany.

ABSTRACT
The field of extracranial vascular anomalies is considered as special focus of pediatric otolaryngology and it has shown a rapid development during the last years. The reason for this interest is finally also due to the global acceptance of the classification introduced by the ISSVA (International Society for the Study of Vascular Anomalies). Hemangiomas are the most frequently observed vascular tumors. Today the systemic propranolol therapy is mostly used for therapy of hemangiomas requiring treatment. Increasingly, the topical application of beta blocker is discussed while the benefit in the head and neck seems to be limited. Vascular malformations are classified according to the morphology of the affected part of the vascular system in arterial, venous, arterio-venous, lymphatic, capillary, and combined vascular malformations. Conventional surgery, sclerosing therapy, and laser treatment are invasive options for the treatment of lymphatic malformations. The options for the treatment of venous malformations could be significantly improved during the last years. In this context, the use of Nd:YAG laser, the conservative treatment of the localized disseminated intravascular coagulation with low-molecular weight heparin, the re-discovery of bleomycin as effective sclerosing agent, and the improvement of alcohol-based embolization agents must be mentioned. Today the treatment with dye laser is the preferred therapy for capillary malformations and it is superior to other therapeutic options as for example photodynamic therapy. Arterio-venous malformations as representatives for high-flow lesions are the high-risk lesions. Frequently they are compared to malignant head and neck tumors, in particular when a curative treatment can no longer be assured because of diffuse or multifocal extent and when the disease shows a progressive course. The combined treatment of embolization and surgical resection and if necessary consecutive defect reconstruction have turned out to be appropriate for arterio-venous malformations. Incurable findings are still a major challenge. Despite the introduction of antiangiogenetic drugs in oncology, the medicamentous therapeutic approach could not be established for arterio-venous malformations up to now.

No MeSH data available.


Related in: MedlinePlus