Bleomycin Sclerotherapy Research Articles

A neonate in emergency for giant auricular and cervical lymphatic malformations: Ultrasound‐guided percutaneous bleomycin sclerotherapy may be a choice

A neonate in emergency for giant auricular and cervical lymphatic malformations: Ultrasound‐guided percutaneous bleomycin sclerotherapy may be a choice

Parotid Gland Microcystic Lymphatic Malformation Producing Obstructive Symptoms

Background: Salivary gland obstruction can present as unilateral, episodic facial swelling. Vascular malformations as a cause of parotid duct obstruction with associated unilateral cheek swelling and pain are rare. Case description: We describe the case of a 16-year-old female with a protracted 2-year history of unilateral facial swelling and pain that was misdiagnosed as recurrent parotitis on computed tomography and sialoendoscopy. Eventually, the 16-year-old female was diagnosed by magnetic resonance imaging to have a microcystic lymphatic malformation of the parotid duct as the cause of her cheek swelling and pain. Afterwards, the patient was referred to undergo interstitial bleomycin sclerotherapy. Conclusions: This case demonstrates a unique microcystic lymphatic malformation producing obstructive symptoms as well as the utility of magnetic resonance imaging for the diagnosis of a patient presenting with recurrent unilateral facial pain and swelling.

Challenging Airway Management in a 5-year-old Male Child with Sublingual Lymphovascular Malformation

ABSTRACT We report a 5-year-old male child with a large lymphovascular malformation of the tongue presenting with signs of airway obstruction scheduled for bleomycin sclerotherapy and tracheostomy. Anesthetic concerns include limited mouth opening, airway obstruction, poor visualization, bleeding, and distorted anatomy, thereby rendering mask ventilation, laryngoscopy, intubation, and possible invasive airway access difficult. While awake airway management options are ideal for difficult airways in general, these techniques may be inapplicable to pediatric patients. Management options are further constrained in resource-limited clinical settings where critical equipment may be unavailable. By conducting a thorough preoperative evaluation and by adopting a multidisciplinary approach to case planning, preparation, and management, a strategy was developed, enabling successful airway management. The use of this approach may facilitate the successful anesthetic management of a difficult pediatric airway in austere clinical environments.

Treatment of Postoperative Neck Dissection Cervical Lymphocele With Percutaneous Bleomycin Sclerotherapy.

Lymphatic leak after lymph node dissection is a rare but well-known surgical complication that is often treated with conservative management and ultimately reoperation. The purpose of this report is to offer an alternative treatment for chyle leak that avoids hospitalization and subsequent surgery. Sclerotherapy has been used to treat lymphatic leaks in the past and has been shown to be safe and effective. This report presents a patient with a known cervical lymphocele who was followed through multiple sclerotherapy appointments until resolution of the lymphocele.

Intralesional Bleomycin Sclerotherapy of Lymphangiomas in Children: Our Initial Experience

Objective − We report our initial experience with intralesional bleomycin sclerotherapy of macrocystic lymphangiomas in three pediatric patients.Case Reports − Case 1. A 3.5-month-old male child presented to our institution with a radiologically verified macrocystic lymphangioma of the left thoracoabdominal region. After 2 cycles of sclerotherapy complete regression of the tumefact was achieved. Case 2. A 23-month-old male child presented with a radiologically confirmed lymphangioma in the sternal region. In total, he underwent 6 cycles of sclerotherapy in about 7 months. At first there was no response to therapy, but after the last cycle, the end result was excellent. Case 3. A 2-month-old male child presented with a radiologically confirmed lymphangioma of the left axillary region. He underwent 4 cycles of sclerotherapy in 4 months. The end result was excellent - complete regression of the tumefact.Conclusion – In all our cases, intralesional bleomycin sclerotherapy was successful alone and showed very good end results. There were no serious side effects in any of our cases. Therefore, bleomycin is a safe alternative to surgical treatment of lymphangiomas in the pediatric population.

Management of the head and neck lymphatic malformations in children: A 7-year experience of 91 surgical cases

ObjectiveTo review the clinical characteristics and treatment outcomes of head and neck lymphatic malformations (HNLMs) in children. MethodsA retrospective study of 91 patients with HNLMs was performed. ResultsThe age ranged from 1 day to 14 years, of which 82.4 % (75/91) were under 2 years old and 45.1 % (41/91) were diagnosed at birth. The diagnostic rates of ultrasound, CT and MRI were 80.2 % (73/91), 90.1 % (82/91) and 100 % (8/8) respectively. There were 2 cases of complete excision, 8 of bleomycin sclerotherapy, and 81 of subtotal resection combined with bleomycin irrigation. Followed up for 3–93 months, all 91 cases were cured. ConclusionsHNLMs mostly occur within 2 years old, and nearly half of them are present at birth. Characteristic imaging findings can assist clinicians in diagnosis and treatment plan. Subtotal resection combined with bleomycin irrigation may be an appropriate first-line therapy for HNLMs involving the vital anatomical structures.

Abstract No. 197 Efficacy and Safety of Transarterial Bleomycin Sclerotherapy of Early-Stage Facial Arteriovenous Malformation: Single-Center Multidisciplinary Team Experience

To evaluate the efficacy and safety of transarterial bleomycin sclerotherapy of early-stage facial arteriovenous malformation (AVM). A retrospective review was performed of patients who underwent bleomycin sclerotherapy for early-stage AVM (Schobinger stage I or II) in a single-referral vascular anomalies center. Bleomycin was slowly infused transarterially with flow control techniques to prolong the effects of bleomycin. Procedure details, AVM characteristics, and previous treatments were reviewed. Initial therapeutic outcomes were determined by 5 categories using both radiologic and clinical findings in a 6-month follow-up. Further follow-up outcomes were reviewed to evaluate the long-term efficacy and safety of the treatment. Procedure-related complications were also analyzed. Nineteen patients (mean age, 22.4 ± 14.0 years, 14 female) with 31 sessions of sclerotherapies were enrolled. All AVMs were Cho-Do classification type III (type IIIa [n = 13], type IIIb [n = 2], and type IIIa+b [n = 4]). Patients received a mean of 1.6 (range, 1-4) sessions of treatment. The mean cumulative bleomycin dose was 23600 IU ± 14500 (range, 8000–60000 IU). The results showed that 14 patients (74%) patients were responsive to transarterial bleomycin sclerotherapy, including complete response (n = 3), marked improvement (n = 1), and partial improvement (n = 10). The remaining 5 (26%) showed no response. During a mean follow-up of 32.6 months, 5 (26%) showed slight aggravation compared with 6-month outcomes and 14 (74%) were stable. There were only 2 minor complications [hyperpigmentation (n = 1) and cellulitis (n = 1)]. Transarterial bleomycin sclerotherapy using flow control techniques can be a safe and feasible alternative treatment option for facial early-stage AVM.

Assessment of outcomes after intralesional bleomycin sclerotherapy of lymphatic malformations in children.

To evaluate the efficacy of bleomycin in the treatment of lymphatic malformations, and the concordance between photographic and radiological assessments of the outcome. The retrospective study was conducted at the Vascular Anomalies Centre of Indus Hospital, Karachi, and comprised data of patients enrolled with diagnosis of macrocystic or mixed lymphatic malformations from January 2017 to November 2019. All patients had been treated with injection bleomycin 0.6-1mg/kg/session. Size and location of lesions, ultrasonographic findings, photographic documentation and post-procedure complications were reviewed. Photographic and radiographical assessment outcomes were categorised as excellent, good or poor, and compared for concordance. Data was analysed using Stata 14. Of the 31 children, 22(68.8%) were boys. Mean age at presentation was 54.2±44 months (range: 2 months to 15.7 years). There were 32 lymphatic malformations; 29(90.6) macrocystic and 3(9.4%) mixed. Head and neck region was mostly involved 19(59.4%). Most lesions 23(71.9%) presented during the first year of life, and 29(90.6%) lesions were purely macrocystic. Excellent, good and poor response was seen in 16(50%), 15(46.9%) and 1(3.1%) lesions on photographic assessment, and 21(65.6%), 11(34.4%) and 0(0.0%) lesions on radiological assessment, respectively. Concordance in photographic and radiological outcomes was 22(69%). No complications were seen and no statistically significant difference was observed for photographic and radiographic assessment with respect to gender, malformation type, region involved, and number of sessions (p>0.05). Intralesional bleomycin sclerotherapy was found to be effective in the treatment of lymphatic malformations. Clinical observation was reliable in assessing progress on routine follow-up, with additional radiology done when management decisions needed to be reviewed.

Efficacy and safety of transarterial bleomycin sclerotherapy of early-stage facial arteriovenous malformation: Single-center multidisciplinary team experience

To evaluate the efficacy and safety of transarterial bleomycin sclerotherapy of early-stage facial arteriovenous malformation (AVM). A retrospective review was performed of patients who underwent bleomycin sclerotherapy for early-stage AVM (Schobinger stage I or II) in a single-referral vascular anomalies center. Bleomycin was slowly infused transarterially with flow control techniques to prolong the effects of bleomycin. Procedure details, AVM characteristics, and previous treatments were reviewed. Initial therapeutic outcomes were determined by 5 categories using both radiological and clinical findings in a 6-month follow-up. Further follow-up outcomes were reviewed to evaluate the long-term efficacy and safety of the treatment. Procedure-related complications were also analyzed. Nineteen patients (mean age 22.4±14.0 years, 14 females) with 31 sessions of sclerotherapies were enrolled. All AVMs were Cho-Do classification type III (type IIIa [n=13], type IIIb [n=2], and type IIIa+b [n=4]). Patients received a mean of 1.6 (range, 1-4) sessions of treatment. The mean cumulative bleomycin dose was 23,600 IU ± 14,500 (range, 8000 - 60,000 IU). The results showed that 14 patients (74%) were responsive to transarterial bleomycin sclerotherapy, including complete response (n=3), marked improvement (n=1), and partial improvement (n=10). The remaining 5 (26%) showed no response. During a mean follow-up of 32.6 months, 5 (26%) showed slight progression compared with 6-month outcomes and 14 (74%) were stable. There were only 2 minor complications [hyperpigmentation (n=1) and cellulitis (n=1)]. Transarterial bleomycin sclerotherapy using flow control techniques can be a safe and feasible alternative treatment option for facial early-stage AVM.

Efficacy and Safety of Intralesional Bleomycin for Treatment of Lymphangioma: Report from a Tertiary Care Hospital of Bihar

Background: Lymphangioma is a benign tumor of lymphatic vessels, with 75% cases occurring in head and neck. Surgical excision is the traditional management. Intralesional sclerotherapy has become a method of treatment for lymphangiomas in children. A retrospective clinical trial was conducted to evaluate the efficacy of intralesional bleomycin sclerotherapy (IBS) in the treatment of lymphangiomas in children. Methodology: A prospective study was conducted by the Department of General Surgery of MGM Medical College, Kishanganj, Bihar. Study was commenced after getting the ethical approval from the Institutional ethical committee. The period of data collection was 2 years that is from October 2019 to September 2021. The response of IBS was assessed clinically and on the basis of color Doppler USG. Results: 36 patients of lymphangioma were included in the study. 63.9% patients were seen before 1 year of age. Of all, 75% of the cases that is 27 patients had cystic hygroma, 3 were cavernous, and 6 were of mixed type. The neck region was the most common site with 25 (69.4%) patients. 19.4% required single dose. 11 patients developed side effects. Conclusion: Complications can also occur postoperatively o

Interstitial bleomycin sclerotherapy in children with vascular malformations: Our initial experience in Hong Kong

AbstractBackgroundVascular malformations represent a wide spectrum of disorders in children. Recently, interstitial bleomycin sclerotherapy has been shown to be a safe and effective treatment for selected cases of vascular malformation in children and adults.AimTo evaluate the short‐term outcome and safety of interstitial bleomycin sclerotherapy in children with vascular malformations.MethodsThis is a retrospective study in which patients under 18 years old with vascular malformation undergoing bleomycin sclerotherapy between August 2019 and January 2022 in Hong Kong were included. Relevant demographics of the included patients were collected. Short‐term outcomes including clinical response, immediate and early complications were evaluated.ResultsFour patients who aged from 4 to 8 years old were identified, three with lymphatic malformation and one with arteriovenous malformation. A total of eight sessions of interstitial bleomycin sclerotherapy were performed. Three of them reported clinical response with either reduction in lesion size or reduction in discomfort or disfigurement. No immediate complication was reported. However, one of them experienced post‐operative hyperpigmentation with scratch marks.ConclusionThe experience in the use of interstitial bleomycin sclerotherapy in children with vascular malformations is still limited in our locality. Further study with larger cohorts and longer follow‐up is required to further establish its efficacy and safety profile in paediatric patients.

Conservative treatment of Head and Neck hemangiomas using Intralesional Bleomycin.

Hemangiomas are vascular tumours and commonly occur in head and neck region. Complete treatment of these vascular swellings are often challenging. As surgical excision carries high risk of complications and poor cosmetic outcome, treatment is shifted more towards non-surgical modalities like steroid therapy, radiotherapy, chemotherapy and sclerotherapy. To study the efficacy of intralesional Bleomycin sclerotherapy for head and neck hemangiomas. Seventeen patients ( 9 males and 8 females) with head and neck hemangiomas were treated with sclerotherapy using intralesional bleomycin injection ( 0.1-0.5mg/kg/ dose) in a medical college of India. Details of the patients were recorded along with serial photographs of lesion. Post injection outcomes in form of reduction of lesion size, patient satisfaction and complications were also recorded. 11 patients were completely cured, 3 had more than 50% reduction in size, one patient showed minimal reduction and two had no response. One patient had superficial ulceration, one case of slough and fever was reported. None of the patients developed severe toxic side effects and pulmonary fibrosis with follow up of 18 months. Bleomycin injection is safe, easy and well tolerated method for treatment of head and neck hemangiomas. We recommend surgery only if there is no response to other conservative treatment modalities.

Safety and Efficacy of Bleomycin Slow Infusion Sclerotherapy Using a Syringe Pump for Microcystic and Mixed Lymphatic Malformations.

To evaluate the safety and efficacy of bleomycin infusion sclerotherapy using a syringe pump in microcystic and mixed (microcystic components with the presence of a cyst over 1cm) lymphatic malformations (LMs). Patients who received bleomycin sclerotherapy with a syringe pump for microcystic or mixed LMs were reviewed. Cystic components of LMs were accessed under sonographic guidance, followed by injection of an opacified bleomycin solution using a syringe pump (infusion rate, 10-20mL/h) under fluoroscopic guidance. Imaging outcomes were graded as complete (> 90% size reduction), partial (25-90%), or no response (< 25%). Clinical outcomes and procedure-related complications were also reviewed. Forty-nine patients with 81 sclerotherapies were analyzed. The mean age was 17years (range 0.1-65 y). Thirty-one (63%) patients had microcystic LMs, and 18 (37%) had mixed. A mean of 1.7 sessions (range 1-4) of sclerotherapy was performed using a mean cumulative dose of bleomycin of 10.8 U (range 1.5-39 U). The mean infusion time was 39min (range 14-130min). Regarding imaging outcomes, there was a complete response in 29% (n = 14), a partial response in 57% (n = 28), and no response in 14% (n = 7). Regarding clinical outcomes, there was a complete response in 39% (n = 19), a partial response in 51% (n = 25), and no response in 10% (n = 5). According to the CIRSE classification, no major complications were identified. Bleomycin slow infusion sclerotherapy provides gradual filling of sclerosant to target microcystic components. This technique is safe and feasible for the management of microcystic or mixed LMs. Level 4, Case series.

Two-Year Outcomes of Transcutaneous Non-Image Guided Bleomycin Sclerotherapy in Conjunctival Lymphatic Malformations: A Protocol-Based Management in 16 Eyes.

To study the efficacy and the 2-year outcomes of treating conjunctival lymphatic malformations (LM) with protocol-based bleomycin sclerotherapy. A retrospective interventional study of 16 eyes with conjunctival LM treated with bleomycin sclerotherapy between December 2016 and 2019. A clinical resolution was assessed as poor (less than 25% decrease in size), fair (25%-50% decrease in size), good (50%-75% decrease in size), excellent (more than 75% decrease in size), and complete resolution. Mean age at presentation was 18 ± 13.09 (15 years, 3 to 59 years) years. The conjunctival component was classified based on clinical appearance as conjunctival mass (12) and microcystic LM (4). Mean clock hours of involvement were 3.32 ± 5.29 clock hours (4, 2-9 clock hours). An average per session dose of 1.8 ± 0.3 IU (median 2 IU, range 1-2 IU) and a cumulative dose of 3 ± 1.5 IU (3, 1-6 IU) of bleomycin were injected over an average of 1.6 ± 0.7 (median 2, range 1-3) treatment sessions per patient. Excellent response was observed in 11 (69%) cases. A residual lesion requiring surgical debulking was noted in 1 case. Recurrence was noted in 2 (13%) cases one of which was treated with repeat sclerotherapy resulting in complete resolution. Adverse reactions included restricted extraocular motility in extreme gaze in 2 eyes (13%). Sustained tumor resolution was observed over a mean follow-up of 29.24 + 9.45 months (24, 24-38 months). Bleomycin sclerotherapy gives excellent response in conjunctival LMs and is an effective first-line therapy in these cases.

Therapeutic Effects of Intralesional Bleomycin Sclerotherapy for Non-Invasive Management of Low Flow Vascular Malformations - A Prospective Clinical Study.

Bleomycin, a cytotoxic and antitumour drug, is safe and effective in the management of vascular anomalies prevalent in the head and neck region. The aim of our study was to evaluate the effect of intralesional bleomycin injection in vascular malformations (VMs), especially venous and lymphatic malformations present extracranially on the face, lips and intraorally. This prospective clinical study was conducted in the Department of Oral and Maxillofacial Surgery, Government Dental College, Srinagar. The study included 30 patients with low-flow VMs (LFVMs) wherein the effectiveness of intralesional bleomycin sclerotherapy was evaluated. The recorded data was compiled and continuous variables were expressed as mean ± standard deviation and categorical variables were summarised as frequency and percentages. Complete resolution (cure) was observed in 11 patients (36.66%), marked improvement in 17 patients (56.66%) and mild improvement in two patients (6.66%). Local complications were superficial ulcerations in 14 patients (46.66%) and hyperpigmentation in one patient (3.33%). Systemic complications in the form of flu like symptoms, nausea or vomiting were not reported in any of the above-mentioned patients. Signs of pulmonary fibrosis and/or hypertension were also not reported in any of the above cases. Intralesional bleomycin injection is a potent and safe therapeutic alternative for the treatment of haemangiomas and LFVMs. Such patients can be managed on an outpatient basis without the need of any extensive surgery, expensive armamentarium and with only minor complications.

Compare the Outcomes of Sclerotherapy with Bleomycin Versus 15% Hypertonic Saline in Children with Cystic Hygroma

Objective: The goal of this research is to evaluate the efficacy of bleomycin sclerotherapy against hypertonic saline (at 15%) in treating cystic hygroma in children. Study Design: Comparative study Place and Duration: Children Hospital, Pakistan Institute of Medical Sciences PIMS Islamabad. July 2021-Feb 2022. Methods: There were 52 children of both genders with cystic hygroma were included in this study. Included children had age 2 months to 12 years. After taking informed written consent from the parents of children detailed demographics age, sex, weight and place of living were recorded. Patients were equally categorized in two groups. 26 patients in group I received sclerotherapy with bleomycin and in group II 26 children received 15% hypertonic saline. Post-treat outcomes among both groups were assessed and compared. SPSS 22.0 was used to analyze all data. Results: Among 52 children, there were 32 (61.5%) males and 20 (38.5%) females. Mean weight of the children was 14.7±5.37 kg and mean age was 6.9±9.54 years. Majority of the cases 34 (65.4%) were from rural areas and 18 (34.6%) were had urban residency. Most common site of lymphangioma was neck and axilla. In group I 18 (69.2%) children received four sessions of bleomycin. We found higher number of effectiveness in patients of group I 25 (96.2%) as compared to group II in 22 (84.6%) cases with p value &lt;0.009. Frequency of wound infection and recurrence rate was also higher in group II. Conclusion: We concluded in this study that the use of sclerotherapy with bleomycin was an effective and useful in the treatment cystic hygroma children in terms of higher number of excellent results as compared to 15% hypertonic saline. Except this recurrence rate and complications were also not seen in sclerotherapy with bleomycin group. Keywords: Bleomycin, Sclerotherapy, Cystic Hygroma, Recurrence, Wound Infection, 15% Hypertonic Saline

Pharmacokinetics of bleomycin sclerotherapy in patients with vascular malformations.

Bleomycin, a chemotherapy agent that inhibits synthesis of DNA, has been increasingly utilized in sclerotherapy for patients with vascular malformations. A serious long-term risk of intravenous bleomycin is dose-dependent interstitial pneumonitis. Little is known about absorption and circulating levels of bleomycin when used in sclerotherapy for patients with vascular malformations. This is an Institutional Review Board (IRB)-approved prospective study on patients receiving bleomycin sclerotherapy in the management of vascular malformations. Depending on the type of vascular malformation, bleomycin was administered either in the lumen or interstitial space of the involved lesion. A bleomycin assay measured serum bleomycin plasma concentrations versus time at seven intervals following treatment. Pharmacokinetic parameters were obtained for each participant and included peak plasma concentration (Cmax ), time to reach peak plasma concentration (Tmax ), volume of distribution (Vd ), elimination half-life (t1/2 ), the volume of plasma cleared of the drug per unit time (CL), and total systemic exposure area under the curve (AUC). Fifteen patients were enrolled (5: lymphatic, 4: venous, 6: arteriovenous malformations). Bleomycin was administered interstitially (IS) in 11 patients and intraluminal (IL) in four; median age of 13years (range: 2-67). Pharmacokinetic analysis revealed terminal elimination half-life (t1/2λz ) of 88.51 (±23.09) and 111.61 (±37.75) minutes for the IS and IL groups, respectively. Vd was 4.86L (±6.74) and 1.55L (±0.54) for the IS and IL groups, respectively. AUC was 53.9 (±23.45) and 129.17 (±93.57) mgmin/L for the IS and IL groups, respectively. There were no statistically significant differences in t1/2λz , Vd , or AUC parameters between groups. Bleomycin is absorbed systemically when used as a sclerosant for vascular malformations when injected either IS or IL.

Liposuction-Like Sclerotherapy Technique for Microcystic Lymphatic Malformation

BackgroundThe treatment for microcystic lymphatic malformation (LM) remains challenging. We describe the liposuction-like sclerotherapy technique, a new treatment for extensive microcystic LM.MethodsLM data was retrospectively reviewed. This study included patients with a microcystic LM component treated by liposuction-like technique with bleomycin sclerotherapy.ResultsBetween June 2016 and October 2019, 39 consecutive patients (male/female ratio: 21:18; mean age, 33.6 months; range: 5 months to 15 years) with microcystic LM were treated by liposuction-like sclerotherapy (LS-LS) technique. Fifty-six sessions of LS-LS were performed (mean of 1.44 sessions per patient; range: one to four sessions). Follow-up ranged 6-30 months (mean of 21 months). We observed no major complications. Transient minor complications included: postoperative noninfectious fever, vomiting, temporary skin edema, pigmentation, mild local depressions, and/or irregularities, and a small hyperpigmented scar at the incision. No postoperative infection, skin ulcer, or necrosis occurred. The patients’ symptoms were successfully resolved or stable. A sub-complete response and partial response were observed for 26 (76%) and 13 patients (33%), respectively.ConclusionThe LS-LS technique for microcystic LMs is safe, feasible, and effective. This technique is an effective intervention with which it is possible to manage and potentially cure microcystic LM clinically.

Application of surgery combined with bleomycin irrigation for complex cervical-facial lymphatic malformations in children

Objective:To present experience and evaluate the safety and efficacy of surgery combined with bleomycin irrigation for the management of head and neck lymphatic malformations in children. Methods:The medical records of all patients with cervical-facial lymphatic malformations who presented to Shanghai Children's Hospital from August 2014 to December 2020 were reviewed. 97 children were divided into surgery group（81 cases） and sclerotherapy group（16 cases）. Conventional contrast-enhanced magnetic resonance imaging（MRI） and B-ultrasound examinations were performed both preoperatively and postoperatively. The surgical group received lymphangioma resection combined with bleomycin irrigation. The sclerotherapy group was treated with B-ultrasound-guided percutaneous lymphangioma aspiration and bleomycin sclerotherapy. SPSS 21.0 software was used to evaluate the clinical cure rate and postoperative complications of lesions in both groups by chi-square test. Kaplan-Meier method was used to calculate the disease-free survival rate and draw survival curve. Results:In the surgery group of 81 children, 64 cases were cured and 17 cases were effective while in the sclerosis group, 8 cases were cured and 8 cases were effective. Cox proportional risk model found that children in the surgery group had a higher cure rate and a lower risk of 5-year recurrence than those in the sclerotherapy group, with statistically significant differences（χ²=5.814, P<0.05）. The risk of recurrence in the surgery group was 35.4% of that in the sclerotherapy group（HR=0.354, P<0.05）. In regards to postoperative complications, the surgical group had no higher rate of temporal facial paralysis and other nerve injuries compared to the sclerotherapy group（χ²=1.041, P=0.308）. Conclusion:Surgery combined with bleomycin irrigation in the complex cervical-facial lymphatic malformations was confirmed to be effectively and safely. The principle of the surgery was to protect the structure and function of normal tissue while excising the lesions as much as possible. When the lesions involved the posterior two-thirds of the tongue, the floor of the mouth, parapharynx, retropharynx, or hypopharynx spaces. Radiofrequency ablation was used in the surgical excision, which made the surgery more minimally invasive, accurate and personalized.

Sandwich therapy in the management of propranolol resistant infantile hemangioma of the lip

RationalePropranolol has evolved as a first line management of infantile haemangiomas. Nevertheless, the resistance to propranolol has warranted alternative treatment modalities. We hypothesize that combination of medical and surgical therapy (sandwich therapy) to be beneficial in the management. MethodsPatients were divided into three groups (total=31), Group A (bleomycin sclerotherapy), Group B (surgical group), Group C (sandwich therapy). A p value <0.05 was taken as significant. ResultsIn Group A 54.5% of patients had excellent response, 27.3% partial response and 18.2% had no response. Comparing cosmetic outcome, 25% of patients in Group B and 16.7% of patients in Group C had excellent upshot. On the contrary 18.2% of patients in bleomycin had unsatisfactory and 18.2% had poor cosmetic outcome. Sandwich therapy was cosmetically more acceptable than Bleomycin sclerotherapy (p- value = 0.049). In terms of recurrence, sandwich therapy differed significantly from surgical therapy with fewer recurrences (p-value= 0.049). ConclusionSandwich therapy is superior to bleomycin sclerotherapy in terms of cosmetic outcome and has fewer recurrences compared to surgical group and requires single stage resection. However, further studies with the help of Doppler ultrasound are required in this regard.