Management of vascular malformations and hemangiomas of the head and neck - an update

Abstract

We are witnesses of improved therapeutic strategies and intensified multidisciplinary and international exchange in the field of vascular anomalies of the head and neck region. This review summarizes today's 'state of the art' in treatment and points out recent developments in clinical management of hemangiomas and vascular malformations of the head and neck. Despite the general acceptance of the 'Hamburg classification', inappropriate use of the term 'hemangioma' is still found in scientific correspondences. The majority of problematic infantile hemangiomas are nowadays successfully treated with propranolol. Topical use of β blockers is the most recent development for hemangiomas. The understanding of the condition called 'localized intravascular coagulopathy' has significantly improved the clinical management of venous malformations apart from the introduction of sophisticated ethanol-based embolization agents. No significant improvement in the management of lymphatic or capillary malformations of the head and neck has been observed within recent years. The liquid embolization agent Onyx has become popular in the treatment of extracranial arteriovenous malformations (AVM), but can be associated with severe perivascular inflammation. β Blockers are the first-line modality for infantile hemangiomas, which require active treatment. Reports on pharmacotherapy of lymphatic malformations with sildenafil are subject to critical evaluation regarding drug safety. Pulsed dye laser treatment is still the 'gold standard' for capillary malformations. Surgical excision combined with intravascular embolization is treatment of choice for AVM with the knowledge that extensive AVM are still not curable.