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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

Staging of lymphatic malformations of the head and neck according to [15]
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Related In: Results  -  Collection

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T3: Staging of lymphatic malformations of the head and neck according to [15]

Mentions: The knowledge of the above-mentioned particularities of lymphatic malformations, however, is not sufficient to always assure an adequate classification. It is desirable to have a further optimized specification of those lesions of the head and neck not only allowing a therapeutic decision and prognostic estimation but also a comparison of therapeutic results. De Serres and co-workers [15] were the first to introduce a staging system classifying lymphangiomas of the head and neck into five stages according to anatomic aspects (Table 3 (Tab. 3)). Hereby the authors could show that the complication rate of the surgical therapy and the number of necessary therapeutic interventions is correlated to a more advanced stage – this observation could also be reported by other authors [16]. In this context the group around Wittekindt developed a morbidity correlated score system, the so-called Cologne Disease Score that aimed at establishing a comprehensive clinical estimation with regard to speech, swallowing, and breathing function as well as aesthetic aspect [17], [18]. In the head and neck region, the affection of the tongue plays a decisive role regarding function and prognosis. The involvement of the tongue, however, was neither included in the classification of de Serres nor in the Cologne Disease Score. In 2009, in order to compensate this deficit, Wiegand and co-workers introduced a staging for lymphatic malformations of the tongue classifying the affection of the tongue into the stage I–IV [19]. Stage I includes isolated superficial microcystic lymphatic malformations of the tongue, stage II describes lymphatic malformations affecting the tongue with muscle involvement (IIA: part of the tongue. IIB: entire tongue). The floor of the mouth is involved in stage III; and stage IV describes extensive microcystic lymphatic malformations involving the tongue, floor of mouth, and further cervical structures. The quintessence of the Marburg results revealed that a complete resection of the lesion is only possible in stages I and IIa and that generally all other stages may not be appropriate for complete resection with organ preservation.


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)

Staging of lymphatic malformations of the head and neck according to [15]
© Copyright Policy - open-access
Related In: Results  -  Collection

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

T3: Staging of lymphatic malformations of the head and neck according to [15]
Mentions: The knowledge of the above-mentioned particularities of lymphatic malformations, however, is not sufficient to always assure an adequate classification. It is desirable to have a further optimized specification of those lesions of the head and neck not only allowing a therapeutic decision and prognostic estimation but also a comparison of therapeutic results. De Serres and co-workers [15] were the first to introduce a staging system classifying lymphangiomas of the head and neck into five stages according to anatomic aspects (Table 3 (Tab. 3)). Hereby the authors could show that the complication rate of the surgical therapy and the number of necessary therapeutic interventions is correlated to a more advanced stage – this observation could also be reported by other authors [16]. In this context the group around Wittekindt developed a morbidity correlated score system, the so-called Cologne Disease Score that aimed at establishing a comprehensive clinical estimation with regard to speech, swallowing, and breathing function as well as aesthetic aspect [17], [18]. In the head and neck region, the affection of the tongue plays a decisive role regarding function and prognosis. The involvement of the tongue, however, was neither included in the classification of de Serres nor in the Cologne Disease Score. In 2009, in order to compensate this deficit, Wiegand and co-workers introduced a staging for lymphatic malformations of the tongue classifying the affection of the tongue into the stage I–IV [19]. Stage I includes isolated superficial microcystic lymphatic malformations of the tongue, stage II describes lymphatic malformations affecting the tongue with muscle involvement (IIA: part of the tongue. IIB: entire tongue). The floor of the mouth is involved in stage III; and stage IV describes extensive microcystic lymphatic malformations involving the tongue, floor of mouth, and further cervical structures. The quintessence of the Marburg results revealed that a complete resection of the lesion is only possible in stages I and IIa and that generally all other stages may not be appropriate for complete resection with organ preservation.

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