Intralesional therapies for vascular malformations of the head and neck

Abstract

Vascular malformations in the head and neck region are complex anomalies that represent a diagnostic and therapeutic dilemma for treating physicians. These lesions are divided into fast and slow flow lesions. The most common fast flow lesion encountered in the head and neck is the arteriovenous malformation (AVM). Slow flow malformations are comprised of venous (VM), lymphatic (LM), or lymphatic-venous malformations (LVMs). LMs are often classified as macrocystic, microcystic, or mixed, a pertinent feature when determining suitability for intralesional therapy. Vascular malformations are often best managed by a multidisciplinary team of surgeons (general, otolaryngology, plastics, and orthopedics), dermatologists, hematologists, diagnostic, and interventional radiologists and geneticists, where indicated such as in syndromic cases. Diagnosis is usually made based on a combination of factors: prenatal imaging, age of presentation, clinical appearance and course, and imaging with ultrasound and MRI, as this modality serves as the gold standard imaging technique for these malformations. Indications for treatment are largely dependent on whether the malformation has impact on life, function, or cosmesis, as determined by presentation.Symptoms can range from life-threatening such as stridor due to airway obstruction, to pain, swelling, disfigurement, infections, bleeding, and consumptive coagulopathy. Surgical resection is a rea-

Gingival lymphatic malformation. An atypical case report

“…In relation to the clinical management of the case, in our case, due to the size and location, we decided to proceed with surgical removal and its subsequent histopathological study, which is the treatment of choice for small and superficial lesions. On the other hand, in larger lesions and where there may be a post-surgical functional problem, treatment with sclerosing agents may be considered, including bleomycin, OK-432, alcohol, polidocanol or others ( 14 , 15 ).…”