Current concepts in the classification, diagnosis and treatment of hemangiomas and vascular malformations of the head and neck

Abstract

There are many different classifications of vascular anomalies. As the correct classification of the vascular lesion has a direct influence on therapy it is difficult to decide which treatment should be considered as the treatment of choice. Based on an extensive review of the literature and personal experience of the treatment of more than 200 patients with hemangiomas or vascular malformations of the head and neck, a clinical classification is described that allows vascular lesions to be categorized in order to plan purposeful treatment. In general, hemangiomas represent the main group of vascular lesions in infancy and childhood. They are usually apparent a few weeks after birth and are characterized by an initially rapid growth of epithelial cells, followed by spontaneous involution. Hemangiomas should be differentiated from vascular malformations that are present at birth but may not be evident clinically. Spontaneous involution of vascular malformations has never been reported, whereas laser therapy can induce involution of hemangiomas at an early stage in a majority of cases. In certain situations steroids or surgical removal may seem to be the appropriate therapy of choice. In contrast, vascular malformations have to be treated according to their histopathology and location, as well as their hemodynamic features as shown radiographically with angiography. The accurate diagnosis of vascular anomalies is essential for further treatment, as shown by clinical experience at the University of Marburg.

Dermatological manifestations of nervous system diseases

“…hereditary haemorrhagic teleangiectasia -HHT) jest uwarunkowaną genetycznie, dziedziczoną w sposób autosomalny dominujący naczyniową skazą krwotoczną, która charakteryzuje się obecnością poszerzonych, patologicznych, łatwo krwawiących naczyń krwionośnych -malformacji naczyniowych. W klasyfikacji malformacji naczyniowych z 2005 roku choroba ROW jest zaliczana do malformacji kapilarnych [10,11]. Cechuje ją występowanie malformacji naczyniowych w skórze, błonach śluzowych i narządach trzewnych (płuca, wątroba, przewód pokarmowy, układ moczowy) oraz w OUN i narządzie wzroku.…”

Hemangioma subglótico tratado con propranolol: Una nueva alternativa terapéutica. Caso clínico

“…Histológicamente, se caracterizan durante su fase de proliferación por un alto índice mitóti-co de células endoteliales dentro de los capilares, seguido por apoptosis y la sustitución con tejido fibroadiposo a medida que progresa a la fase de involución. Todos los hemangiomas infantiles presentan inmunorreactividad histoló-gica positiva frente al GLUT-1 que corresponde a un transportador de glucosa transmembrana que se expresa en las células endoteliales de hemangiomas infantiles, placenta y barrera hematoencefalica [1][2][3] y no en otros endotelios, ni otros tumores vasculares.…”

“…Es más frecuente en mujeres, prematuros y recién nacidos menores de 1.500 g. El 80% de los hemangiomas se localizan en cabeza y cuello [1][2][3] .…”

“…Los hemangiomas infantiles requieren tratamiento cuando presentan riesgo vital, presentan alteraciones funcionales tales como compromiso de vía área y cuando presentan deformaciones cosméticas de importancia [1][2][3] .…”

Intraoral Venous Malformation With Phleboliths – A Case Report With Review of the Literature.

“…These are present at birth but hardly make their presence obvious. The classification of hemangiomas and vascular malformations was clearly emphasized by mulliken et al 7,8 It is based on their biological characteristics. Disturbances in vasculogenesis and angiogenesis leads to defects in the capillaries, veins, arterioles, lymphatics or combination of vessels.They are typically divided according to the blood flow into low-flow (capillary malformation, lymphatic malformation, and venous malformation) and high-flow lesions (arteriovenous malformations, arteriovenous fistulae).…”