Medical management of vascular anomalies of the head and neck

• Published in: Journal of oral pathology & medicine Vol. 51; no. 10; pp. 837 - 843
• Main Author: Léauté‐Labrèze, Christine
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01.11.2022; John Wiley and Sons Inc
• Subjects: Arteriovenous Malformations - drug therapy; betablockers; Class I Phosphatidylinositol 3-Kinases - genetics; Class I Phosphatidylinositol 3-Kinases - therapeutic use; Head and neck; Hemangioma; Humans; Inflammation; Invited Review; Invited Reviews; Medical treatment; mTOR; Neck - pathology; Patients; Propranolol; PROS; Rapamycin; Sirolimus - therapeutic use; Tumors; vascular malformation; Vascular Malformations - drug therapy; Vascular Malformations - pathology; hemangioma; mTOR; PROS; vascular malformation; betablockers
• ISSN: 0904-2512; 1600-0714
• DOI: 10.1111/jop.13324

Depending on impairment, treatment of vascular anomalies is decided on a case‐by‐case 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.