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  • Title: [Head and neck hemangiomas: how and when to treat].
    Author: Zheng JW, Wang YA, Zhou GY, Zhu HG, Ye WM, Zhang ZY.
    Journal: Shanghai Kou Qiang Yi Xue; 2007 Aug; 16(4):337-42. PubMed ID: 17924011.
    Abstract:
    Hemangiomas are common benign vascular tumors of infancy characterized by a proliferative growth phase followed by very slow inevitable regression (involutive phase) between one to ten years of age, about 60% to 70% of the lesions are found in the head and neck region. There are many treatment modalities reported in the literature for head and neck hemangiomas, including wait and see policy, drug therapy, sclerotherapy (steroids, bleomycin), cryotherapy, isotope radiotherapy, laser therapy, and surgical therapy. There still exist many controversies over the optimal treatment options for individual patient. Based on our clinical experience on 250 cases and literature review, a rational treatment regime for head and neck hemangioma was proposed in this study: (1) As it is not possible to predict, whether a hemangioma will remain small and unproblematic or grow into a very large lesion, early therapy is the only way out of this dilemma. A white or pink macule, a port-wine stain-like lesion initially appearing in the children can be effectively and easily removed by laser, thus preventing a growth in the size in the early stage. (2) The term of "wait and see" should be substituted by "close observation", and this approach should only be reserved for hemangiomas which are without visible growth or in the involutive phase. (3) Systematic drug therapy (steroids, interferon alpha-2a ) should be considered for large hemangioma, multiple hemangiomas, life-threatening hemangiomas and hemangiomas with complications such as ulceration, infection, bleeding, dysfunction, etc. Congestive heart failure, consumptive coagulopathy, and thrombocytopenia are also urgent indications for the institution of corticoid therapy. (4) Growing hemangioma can be treated effectively by systematic drug therapy, sclerotherapy, laser therapy or combined therapy. The argon laser (514 nm in wavelength, 0.5 mm in depth) is useful in the treatment of superficial telangiectasias and small, flat cutaneous hemangiomas. Flashlamp-pumped pulsed-dye laser (FPDL, 585 nm or 595 nm in wavelength, 1.0-2.0 mm in depth) can be used in patients with cutaneous and flat hemangiomas at the sites of potential functional impairment. Nd: YAG laser (1064 nm in wavelength) with continuous ice cube cooling is useful for subcutaneous or mixed hemangiomas, and often requires repeated treatments. For larger and deeper hemangiomas up to a depth of 2.0 cm, percutaneous interstitial Nd:YAG laser treatment may be preferred, because it may decrease possible cutaneous skin damage and more effectively reduce bulky, deep lesion. (5) Topical application of imiquimoid and intratumoral injection of steroids or bleomycin can be used in selected patients with rapidly growing hemangioma. (6) The indication for a primary operation is rare and limited to large hemangiomas in the eyelid or hemangiomas on the scalp. Surgical correction of large residuals, especially before formal education begins, to prevent considerable psychosocial impairment is still a well established procedure. The aim of treatment is to counter the proliferative growth, reduce the volume of hemangioma, and initialize the process of regression. Cryotherapy or isotope radiotherapy is nowadays seldom used for the treatment of hemangiomas, due to the high incidence of scarring, pigmentation, or depigmentation. A successful treatment of hemangiomas should be individualized and based on the size of the tumor, the localization, and the therapies available.
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