Vascular Anomalies

Posted by e-Medical PPT Wednesday, August 31, 2011
Vascular lesions in the head and neck region can result in significant cosmetic problems for the patient, and some may lead to even serious life threatening hemorrhage.

Hemangiomas
Hemangiomas, are the most common tumors of the head and neck in infancy and childhood, comprising approximately 7% of all benign soft tissue tumors .
The hemangioma is a true vascular tumor that results from a overgrowth of normal vascular tissue .
It exhibits relatively rapid early growth until approximately 6 to 8 months of age (proliferative phase), followed by regression by 5 to 9 years of age (involutory phase).
It grows by “endothelial proliferation”. During the rapid  growth phase, an increased number of mast cells is seen within the endothelial wall.
The majority of the hemangiomas in infants are noted by the parent within the first month of life.
Hemangiomas are initially noticed as an erythematous, macular patch, which progresses through a rapid proliferative phase whereby it changes its color and grows faster than the commensurate growth of the child.
By the time the patient is 12 months of age most hemangiomas have shown signs of involution. The process of involution is normally slow and will not be completed until the age of 5 to 9 years.

Hemangiomas are found in the superficial tissue, the deep tissue, or both and may affect organ systems such as the liver, lung, spleen, and gastrointestinal tract.
Most superficial hemangiomas can be diagnosed by clinical examination and a detailed and accurate history.
Deep hemangiomas involve muscle or visceral organs and, are more difficult to diagnose. Therefore, further diagnostic studies are required.
Intra-osseous hemangiomas are extremely rare. However the soft tissue lesion may deform the underlying skeleton.
The predilection for females is approximately a 3 :1 ratio.
On examination, the superficial hemangioma usually consists of a raised, reddish to purple tumor with a distinct margin.
In contrast, deep subcutaneous hemangiomas often have a deep bluish hue with normal overlying skin, making diagnosis more difficult.
Both the lesions are firm to palpation and do not pulsate or exhibit any thrills or bruits.

Computed tomography (C. T .Scan) and Magnetic resonance imaging ( M. R. I) imaging techniques are used as diagnostic aids to document the extent of the deep hemangiomas.
Arteriography is rarely indicated for the diagnosis of a hemangiomas.

Management
Observation and parental support are the initial approaches in the management of maxillofacial hemangiomas.
If functional compromise such as visual change, airway or masticatory compromise, bleeding, ulceration, or infection occurs intervention is necessary.
This may initially involve cortico-steroids for rapidly proliferating lesions or therapy with interferon alfa-2a.
Surgery is generally reserved for small lesions and as a secondary procedure after initial therapy and involution.
Treatment modalities include routine excision, injection of sclerosing agents, cryotherapy, and ablation using an argon laser.

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