Medical management of vascular anomalies of the head and neck

Abstract

Depending on impairment, treatment of vascular anomalies is decided on a case-bycase basis in pluridisciplinary consultations. Interventional treatments, especially surgery and sclerotherapy, are usually partially efficient and management of patients with vascular anomalies increasingly involves the use of medical drugs. The most common vascular tumor is infantile hemangioma where first-line medical treatment, when necessary, is propranolol. Kasabach-Merritt phenomenon is now largely treated with sirolimus whereas first-line treatment of coagulation disorders associated with venous malformations is based on low-molecular-weight heparins or direct anticoagulants. Sirolimus is the standard treatment for painful inflammatory manifestations of low-flow vascular malformations such capillary, venous, and lymphatic malformations that can occur singly or in combination but PIK3CA inhibitors, originally developed in oncology, have shown promising results in patients with PIK3CA-related overgrowth spectrum. Currently, medical treatments are poorly developed for high-flow malformations such as arteriovenous malformations. However, new research aimed at delineating the different arteriovenous malformations based on molecular findings has given new hope for future development of targeted therapies.

Occurrence of Rhabdomyosarcoma After Surgery Combined with oral Sirolimus for Mixed Vascular Malformation of the Tongue

“…12,13 Sirolimus has been widely used in various refractory vascular malformations. 8,10 However, oral sirolimus did not effectively inhibit the growth of lesions in this patient. On readmission, the mass increased significantly and grew to the neck.…”

“…Sirolimus is a mTOR receptor inhibitor, which can inhibit cell proliferation and angiogenesis and effectively treat various types of vascular malformations 12,13 . Sirolimus has been widely used in various refractory vascular malformations 8,10 . However, oral sirolimus did not effectively inhibit the growth of lesions in this patient.…”

“…At present, surgical treatment is the first choice for oral and maxillofacial lymphatic malformation. At the same time, sclerosing agent injection, interventional embolization, freezing, laser, oral sirolimus, and oral celecoxib can be used for those who cannot completely remove the focus 8–11 …”

“…At the same time, sclerosing agent injection, interventional embolization, freezing, laser, oral sirolimus, and oral celecoxib can be used for those who cannot completely remove the focus. [8][9][10][11] Sirolimus is a mTOR receptor inhibitor, which can inhibit cell proliferation and angiogenesis and effectively treat various types of vascular malformations. 12,13 Sirolimus has been widely used in various refractory vascular malformations.…”

Combining superselective catheterization and electrochemotherapy: A new technological approach to the treatment of high-flow head and neck vascular malformations

“…There are several reports on good treatment outcomes of different vascular malformations: venous and arterial malformations, high- and low-flow, treatment-resistant venous malformations and capillary malformations ( 1 , 10 , 11 , 14 – 16 ). BLM is given either directly into the malformation or intravenously.…”