Nd:YAG Laser Treatment of Massive Tongue Venous Malformation: A Case Report

Abstract

Venous malformations (VM) are slow-flow vascular lesions that result from morphogenesis errors. Composed of dysfunctional veins lacking smooth muscle cells, VMs grow slowly and may initially be managed by observation. Treatment is indicated for lesions that cause functional impairment. One treatment option is laser therapy, which is very effective due to its tissue penetration and relative selectivity. The Nd:YAG laser has been shown to treat small and moderately sized mucosal vascular lesions; in this case, it was applied in a staged approach for treatment of a massive venous malformation of the tongue. A 66-year-old male presented with a venous malformation involving the tongue and lower lip, the lesion estimated to be 10 x 14 x 15 cm in size. The Nd:YAG laser was used in three separate stages to photocoagulate the venous lesion. Follow-up for recurrence is ongoing, but currently shows complete malformation ablation with a 36.2% volume reduction after treatment. The Nd:YAG laser is an effective tool in the treatment of large vascular lesions. Successful laser application in a staged approach for the treatment of a venous malformation of this size and complexity further supports its clinical value. Monitoring for possible recurrence of the venous malformation should be ongoing.

Magnetic resonance – guided treatment of low-flow vascular malformations and the technologies to potentiate adoption

“…The laser induces photocoagulation of the blood in the VM which causes the lesion to involute. The operator can vary the number of treatment stages and power used to effectively treat lesions with a wide range of size and severity ( 22 ). Furthermore, the treatment pulses can be monitored with proton resonance MR thermometry in real time ( 23 ).…”

“…Furthermore, the treatment pulses can be monitored with proton resonance MR thermometry in real time ( 23 ). Due to the adaptability of laser ablation this technique may be more effective in treating large, difficult LFVMs when compared to sclerotherapy ( 4 , 22 ). Moreover, complications associated with this treatment are rare and typically minor, including scarring, tissue necrosis, and dyspigmentation ( 25 ).…”

Update on lasers in pediatric dermatology: how primary care providers can help patients and families navigate appropriate treatment options and timelines

“…Procedural interventions for venous malformations primarily consist of embolization or sclerotherapy, and surgery for glomovenous malformations [17]. Imaging is recommended prior to treatment both to determine the full extent of the malformation, and to exclude a high-flow vascular malformation that requires occlusion of feeder vessels prior to laser [18]. Vascular lasers including PDL and 1064-nm Nd : YAG have been reported to be effective for superficial malformations [18,19].…”

“…Imaging is recommended prior to treatment both to determine the full extent of the malformation, and to exclude a high-flow vascular malformation that requires occlusion of feeder vessels prior to laser [18]. Vascular lasers including PDL and 1064-nm Nd : YAG have been reported to be effective for superficial malformations [18,19]. Combination therapy with both lasers, and novel treatment with dual-wavelength PDL Nd : YAG have shown efficacy [20].…”

“…Combination therapy with both lasers, and novel treatment with dual-wavelength PDL Nd : YAG have shown efficacy [20]. Staged serial Nd : YAG treatments have demonstrated success for large venous malformations [18]. The decision to use lasers in the treatment of venous malformations should be based on symptoms, not age.…”