A Step‐Ladder Protocol to Treat Cervico‐facial Venous Malformations

Abstract

Objectives: Venous malformations (VMs) are the most commonly encountered vascular malformation of the cervico-facial region. Their clinical spectrum is extremely variable as they can present as single small lesions (often confined within muscle fasciae) or huge infiltrating ones. They can be part of a syndrome, as with Bean Syndrome, or in cutaneous mucosal venous malformation syndrome, among others. The aims of the study were: (1) Diagnose and stage a cervico-facial VM. (2) Describe the available treatment for head and neck VMs. (3) Propose the most appropriate treatment based on the staging of the VM. Methods: A review of the pertinent literature was performed to provide the common indications and techniques to treat head and neck VMs. Thirty-four consecutive cases of VMs have been treated by the authors by means of endovascular sclerotherapy with sodium tetradecyl sulphate, surgery, or both. Only patients with intraosseous VMs (8 total) were treated by surgery alone. Three large, unresectable cervicofacial VMs were treated by means of the “strangling technique.” Results: Good to very good aesthetic and functional results were obtained in all 34 patients. All 26 patients who underwent sclerotherapy experienced significant swelling. Six cases of skin or mucosal ulcerations were noted. No damage to the facial nerve was observed. Five patients affected by larger VMs showed partial recanalization/recurrence of the malformation. Conclusions: Cervicofacial VMs have to be managed by an experienced, multidisciplinary team. A protocol with increasing invasiveness is proposed to maximize results after their treatment.