Hemangiomas and Vascular Malformations of the

Hemangiomas and vascular malformations are common place congenital birth marks (i.e. port wine stains) either present at birth or developing during the child's first years of life. In the past, the treatment of these congenital vascular lesions lacked a detailed plan of therapy, partly due to the belief that, given time, they would disappear. This book provides a new classification of the disorder which permits physicians to conduct a more sophisticated diagnosis and to select the most scientific approach of treatment for their removal with minimal blood loss.

Milton Waner and James Y. Suen are the authors of Hemangiomas and Vascular Malformations of the Head and Neck, published by Wiley.

Contributors

xi

(2)

Preface

xiii

(2)

Acknowledgments

xv

1 A Classification of Congential Vascular Lesions

1

(12)

MILTON WANER, M.D.

JAMES Y. SUEN, M.D.

1.1. Hemangiomas

3

(2)

1.2. Vascular Malformations

5

(2)

1.3. Clinical Application

7

(5)

References

12

(1)

2 The Natural History of Hemangiomas

13

(34)

MILTON WANER, M.D.

JAMES Y. SUEN, M.D.

2.1. Proliferation

17

(7)

2.2. Involution

24

(6)

2.3. Complications of Hemangiomas

30

(11)

2.3.1. Ulceration

30

(1)

2.3.2. Airway Obstruction

31

(3)

2.3.3. Auditory Obstruction

34

(1)

2.3.4. Visual Obstruction

34

(2)

2.3.5. Hemorrhage

36

(2)

2.3.6. Congestive Heart Failure

38

(1)

2.3.7. Skeletal Distortion

39

(2)

2.4. Systemic Hemangiomatosis

41

(1)

References

42

(5)

3 The Natural History of Vascular Malformations

47

(36)

MILTON WANER, M.D.

JAMES Y. SUEN, M.D.

3.1. Venular Malformations

50

(12)

3.1.1. Midline Venular Malformations

50

(2)

3.1.2. Venular Malformations (Port-Wine Stains)

52

(8)

3.1.3. Meningeal and Choroidal Involvement

60

(2)

3.2. Venous Malformations

62

(7)

3.3. Lymphatic Malformations

69

(5)

3.4. Arteriovenous Malformations

74

(6)

References

80

(3)

4 The Diagnosis of a Vascular Birthmark

83

(10)

MILTON WANER, M.D.

JAMES Y. SUEN, M.D.

4.1. History

84

(1)

4.1.1. Was the Lesion Present at Birth?

84

(1)

4.1.2. Has It Grown?

84

(1)

4.1.3. Has It Shrunk?

85

(1)

4.2. Physical Examination

85

(3)

4.2.1. Hemangiomas

85

(1)

4.2.2. Vascular Malformations

85

(3)

4.3. Special Investigations

88

(4)

4.3.1. Computerized Axial Tomography

89

(1)

4.3.2. Magnetic Resonance Imaging

89

(1)

4.3.3. Angiography

90

(1)

4.3.4. Histology

90

(2)

References

92

(1)

5 The Surgical Pathology Approach to Pediatric Vascular Tumors and Anomalies

93

(78)

PAULA E. NORTH, M.D.

MARTIN C. MIHM., JR., M.D.

5.1. Normal Vascular System of the Dermis and Subcutis

95

(4)

5.1.1. Structure

95

(2)

5.1.2. Specialized Cellular Functions

97

(2)

5.1.3. Embryology

99

(1)

5.2. Hemangiomas

99

(28)

5.2.1. Histopathology

101

(23)

5.2.2. Pathogenesis

124

(3)

5.3. Vascular Malformations

127

(24)

5.3.1. Lymphatic Malformations

128

(6)

5.3.2. Venous Malformations

134

(8)

5.3.3. Port-Wine Stains (Cutaneous Venulocapillary Malformations)

142

(3)

5.3.4. Arteriovenous Malformations

145

(4)

5.3.5. Mixed, Low-Flow Vascular Malformations

149

(1)

5.3.6. Pathogenesis of Vascular Malformations

149

(2)

5.4. Rare Vascular Lesions of Infancy Associated with Kasabach-Merritt Syndrome

151

(7)

5.4.1. Infantile Kaposiform Hemangioendothelioma

152

(3)

5.4.2. Tufted Angioma (Angioblastoma of Nakagawa)

155

(1)

5.4.3. Infantile Hemangiopericytoma

156

(2)

5.5. Conclusion

158

(1)

References

158

(13)

6 Diagnostic Imaging of Congenital Vascular Lesions

171

(46)

CHARLES A. JAMES, M.D.

6.1. Hemangiomas

174

(7)

6.2. Venous Malformations

181

(8)

6.3. Arteriovenous Malformations

189

(13)

6.4. Lymphatic Malformations

202

(11)

References

213

(4)

7 Psychosocial Impact of Congenital Vascular Lesions

217

(16)

JOSEPH BROGDON, M.A.

7.1. Developmental Overview

218

(1)

7.2. The Psychology of Attractiveness

219

(4)

7.2.1. The Attractiveness Stereotype: "What is Beautiful is Good"

219

(1)

7.2.2. The Advantages of Attractiveness

220

(2)

7.2.3. Psychopathology and Unattractiveness

222

(1)

7.3. Psychosocial Scope of the Phenomenon

223

(1)

7.4. Current State-of-the-Art Clinical Response

224

(1)

7.5. Psychological Sequela of the Vascular-Lesioned Child

225

(4)

7.6. The Family

229

(1)

References

230

(3)

8 Treatment Options for the Management of Hemangiomas

233

(30)

MILTON WANER, M.D.

JAMES Y. SUEN, M.D.

8.1. Pharmacotherapy

234

(8)

8.1.1. Steroids

234

(5)

8.1.2. Interferon

239

(3)

8.2. Lasers

242

(17)

8.2.1. Laser Photocoagulation of Hemangiomas

246

(3)

8.2.2. Skin Resurfacing

249

(4)

8.2.3. Surgical Excision

253

(6)

References

259

(4)

9 The Treatment of Hemangiomas

263

(52)

MILTON WANER, M.D.

JAMES Y. SUEN, M.D.

9.1. Stages in the Life Cycle

271

(1)

9.2. Treatment Modalities

271

(1)

9.3. General Principles

272

(1)

9.4. Treatment According to Stage

273

(20)

9.4.1. General Principles

273

(1)

9.4.2. Early Proliferation

274

(4)

9.4.3. Late Proliferation

278

(4)

9.4.4. Early Involution

282

(3)

9.4.5. Late Involution

285

(8)

9.5. Hemangiomas Requiring Special Consideration

293

(14)

9.5.1. Hemangiomas of the Upper and Lower Lips

293

(5)

9.5.2. Nasal Tip Hemangiomas

298

(4)

9.5.3. Parotid Hemangiomas

302

(1)

9.5.4. Subglottic Hemangiomas

303

(4)

9.6. The Management of Complications

307

(4)

9.6.1. Ulceration

307

(1)

9.6.2. High-Output Cardiac Failure

308

(1)

9.6.3. Kasabach-Merritt Syndrome

308

(3)

References

311

(4)

10 Treatment Options for the Management of Vascular Malformations

315

(36)

MILTON WANER, M.D.

JAMES Y. SUEN, M.D.

10.1. Laser Photocoagulation

316

(10)

10.1.1. Selective Photothermolysis

316

(6)

10.1.2. Nonselective Photothermolysis

322

(2)

10.1.3. Laser Treatment: A Logical Approach

324

(2)

10.2. Techniques

326

(11)

10.2.1. Small Vessel Disorders

326

(5)

10.2.2. Medium Vessel Disorders

331

(2)

10.2.3. Large Vessel Disorders

333

(4)

10.3. Sclerotherapy

337

(5)

10.3.1. Lymphatic Malformations

338

(1)

10.3.2. Venous Malformations

339

(3)

10.4. Surgical Resection

342

(4)

10.4.1. Hemostasis

342

(1)

10.4.2. Extent of Resection

343

(1)

10.4.3. Preservation of Important Structures

344

(2)

10.4.4. Establishment and /or Preservation of Normal Facial Features

346

(1)

10.5. Embolization

346

(2)

References

348

(3)

11 The Treatment of Vascular Malformations

351

(40)

MILTON WANER, M.D.

JAMES Y. SUEN, M.D.

11.1. Midline Venular Malformations

352

(1)

11.2. Venular Malformations

353

(13)

11.2.1. Grades I and II Lesions

357

(1)

11.2.2. Grade IV Lesions

357

(1)

11.2.3. Grade III Lesions

357

(1)

11.2.4. Complications

358

(2)

11.2.5. Response

360

(6)

11.3. Venous Malformations

366

(11)

11.3.1. Venous Malformations of the Lips

366

(5)

11.3.2. Venous Malformations of the Buccal Fat Space

371

(6)

11.4. Arteriovenous Malformations

377

(7)

11.4.1. Preoperative Planning

379

(2)

11.4.2. Embolization

381

(1)

11.4.3. Surgical Resection

382

(2)

11.5. Lymphatic Malformations

384

(5)

11.5.1. Laser Ablation

384

(2)

11.5.2. Surgical Excision

386

(1)

11.5.3. Sclerotherapy

387

(2)

References

389

(2)

Index

391

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Hemangiomas and Vascular Malformations of the Head and Neck

Summary

Author Biography

Table of Contents

Supplemental Materials

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Hemangiomas and Vascular Malformations of the Head and Neck

Summary

Author Biography

Table of Contents

Supplemental Materials

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