Interstitial Nd:YAG Photocoagulation for Vascular Malformations and Hemangiomas in Childhood

• Published in: Archives of otolaryngology, head & neck surgery Vol. 124; no. 4; pp. 431 - 436
• Main Authors: Clymer, Mark A, Fortune, D. Scott, Reinisch, Lou, Toriumi, Dean M, Werkhaven, Jay A, Ries, W. Russell
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Chicago, IL American Medical Association 01.04.1998
• Subjects: Adolescent; Adrenal Cortex Hormones - administration & dosage; Arteriovenous Malformations - surgery; Biological and medical sciences; Catheterization, Peripheral - instrumentation; Child; Child, Preschool; Combined Modality Therapy; Equipment Design; Face - blood supply; Facial Neoplasms - surgery; Female; Follow-Up Studies; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Hemangioma - surgery; Hemangioma, Cavernous - surgery; Humans; Infant; Laser Therapy - instrumentation; Male; Medical sciences; Otorhinolaryngologic Neoplasms - surgery; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract; Treatment Outcome; Human; Corticosteroid; Intralesional administration; Indication; YAG laser; Cardiovascular disease; Systemic route; Cavernous angioma; Vascular disease; Photocoagulation; Prospective; Treatment; Malformation; Surgery; Blood vessel; Head and neck; ENT disease; Benign neoplasm; Child
• ISSN: 0886-4470; 2168-6181; 1538-361X; 2168-619X
• DOI: 10.1001/archotol.124.4.431

BACKGROUND Vascular malformations and cavernous hemangiomas are common in childhood. Although cavernous hemangiomas may resolve spontaneously, aggressive intervention is required when their growth could damage vital adjacent structures, such as the orbit, nose, or tongue. OBJECTIVE To evaluate the efficacy of interstitial Nd:YAG photocoagulation as an adjunct to intralesional and systemic corticosteroids for treatment of hemangiomas and vascular malformations that had failed to respond to other therapies. DESIGN Prospective, nonrandomized trial. SETTING Two referral practices of facial plastic and reconstructive surgery in tertiary care, academic medical centers. PATIENTS Ten consecutive pediatric patients with either hemangioma or vascular malformation of the head and neck. INTERVENTION Laser photocoagulation with an interstitial technique. The Nd:YAG fiber was introduced into the lesion via a 14-gauge angiocatheter needle, and the laser fiber was advanced as coagulation proceeded within the tissue. MAIN OUTCOME MEASURES Decrease in the area of the target lesion, amount of energy applied, and number of treatments required to achieve reduction in size. RESULTS Long-term follow-up demonstrated regression of the lesion in all 10 patients with good cosmetic results. The range of reduction in size was 20% to 98%. No reexpansion of the lesions was noted after a mean follow-up of 13 months. CONCLUSIONS Interstitial photocoagulation of hemangiomas and vascular malformations is an effective treatment for carefully selected patients. When properly applied, this technique can achieve reduction in the size of these lesions without compromising cosmesis.Arch Otolaryngol Head Neck Surg. 1998;124:431-436-->