The use of cryotherapy in the management of intra-oral hemangiomas

Patient satisfaction after sclerotherapy of venous malformations in children

BACKGROUND

We have introduced and performed percutaneous sclerotherapy on pediatric patients, and information regarding the mid- and long-term results after percutaneous treatment of peripheral venous malformations is necessary to counsel patients and their parents about the outcome of the therapy. This study was designed to retrospectively evaluate the long-term satisfaction of pediatric patients following percutaneous sclerotherapy for venous malformations (VMs).

METHODS

A total of 53 children younger than 16 years of age with VMs who underwent sclerotherapy were included in this study. Self-assessment questionnaires regarding the treatment effectiveness and patients' satisfaction were sent to 50 of 53 patients. Sclerotherapy was performed using 3% polidocanol, absolute ethanol, or 5% ethanolamine oleate (EO).

RESULTS

The median numbers of sessions per patient was 2.0 (range, 1-12), and the median follow-up time was 1.8 years (range, 6months-8.3years). Forty-two patients (84%) returned the questionnaire. The most frequent symptom was swelling (95%, 40/42) before sclerotherapy. After treatment, patients felt less pain (82%, 23/28), functional limitation (78%, 14/18), swelling (70%, 28/40), and cosmetic disfigurement (59%, 13/22). None of the patients responded "worse" for any symptoms, and 30 patients (71%) reported being "very satisfied" or "satisfied" with the treatment.

CONCLUSION

Percutaneous sclerotherapy of VMs was safe and effective for relieving symptoms in our pediatric patients, and many of them were satisfied with the outcomes.

Single-Stage Excision of Localized Head and Neck Venous Malformations Using Preoperative Glue Embolization

Objective

Describe single-stage removal of head and neck venous malformations using percutaneous embolization with n–butyl cyanoacrylate ( n-BCA) glue prior to surgical resection.

Study Design

Case series with chart review.

Setting

Tertiary-care pediatric hospital.

Subjects and Results

A total of 169 venous malformations were identified between 2000 and 2012, and 102 (60.1%) were in the head and neck. Thirty-five of 102 (34.3%) were observed, 56 of 102 (54.9%) had invasive therapy, and 11 of 102 (10.8%) underwent n-BCA embolization and surgery (“GES procedure”). The median age of the glue embolization and surgery cohort was 14 years (range, 6-19), and 7 of 11 (63.6%) were female. Treated venous malformations involved the oral cavity/tongue (4/11; 36.4%) and parotid/face (7/11; 63.6%). During facial lesion excision, intraoperative facial nerve monitoring was used. All surgical sites (11/11) were closed primarily. No patient in this cohort had any posttreatment nerve deficits, dysarthria, and dysphagia or lesion persistence.

Conclusions

Localized venous malformations can be treated with preoperative percutaneous embolization with n-BCA glue followed by surgical excision. This technique, with selective motor nerve monitoring, appears safe and allows for complete venous malformation removal with limited nerve dissection, to allow maximal tissue and functional preservation.

Intralesional sclerotherapy for subcutaneous venous malformations in children

BACKGROUND

Venous malformations (VMs) involve multiple anatomical spaces and encase critical neuromuscular structures, making surgical treatment difficult. Recently sclerotherapy has been suggested as the primary treatment for VMs instead of surgical intervention. This report represents eight cases of children with VMs treated with direct percutaneous injections of sclerosing agents, such as ethanol, polidocanol or ethanolamine oleate.

METHODS

All eight patients had large lesions (>3 cm) located on the head, foot, neck and face. Sclerotherapy was performed in an angiographic suite under general anesthesia. Prior to sclerotherapy, percutaneous phlebography was performed in order to visualize the dynamic situation inside the lesion and the draining flow into the adjacent venous vascular system. A 2-15 ml of sclerosing agent was injected into VM lesions under fluoroscopy.

RESULTS AND CONCLUSIONS

An evaluation by MRI examination showed that 6 out of 8 patients had remission, and alleviation of their symptoms without major complications, furthermore one of the lesions apparently disappeared. Intralesional sclerotherapy provides a simple, safe and effective treatment for VMs in the subcutaneous lesions in children.

Surgery combined with copper wire implantation in the management of cavernous orofacial haemangiomas

This paper describes the management of a case of an extensive orofacial haemangioma by surgery combined with copper wire implantation. This technique of copper wire implantation in the management of orofacial haemangiomas was carried out for the first time in Jamaica by the authors. The use of percutaneous copper needles to induce therapeutic coagulation in cavernous haemangiomas, however, is not new, and this has been the basis of the use of copper wire.

Cavernous haemangioma of the head and neck in the adult

This paper reviews a personal experience of 51 cases seen over a 30 year period. Patients were treated in either a combined Head and Neck clinic or a Combined Ophthalmology clinic and a balanced view is thus represented. A method of grading the severity of the disease is described as well as a method of assessing response. This approach has not been proposed hitherto. It is generally concluded that the preferred treatment for small lesions is excisional surgery and for larger lesions carefully planned and highly localized radiation.

Identification of vascular system in experimental carcinoma for cryosurgery--histochemical observations of lectin UEA-1 and alkaline phosphatase activity in vascular endothelium

Histopathologic and histochemical changes in experimental carcinomas following cryotreatment were observed to detect alkaline phosphatase (ALP) activity and UEA-1 lectin binding. Experimental carcinomas were induced in the hamster cheek pouch by topical application of 0.5% DMBA acetone solution twice a week. The cryoprobe at -60 degrees C was directly attached to the tumor surface for 90 sec. Histochemically, the tumor tissue following cryotreatment was completely destroyed in the surface area by the direct freezing and such cryonecrotic tumor tissue lacks stainability. Soon after cryotreatment and before cryonecrosis takes place, it has been observed that there is an intense dilatation of capillary vessels. Histochemically, high ALP activity was limited to capillary endothelium and to inflammatory cells. Lectin UEA-1 staining was usually found in both normal and neoplastic epithelial cells which were confined to capillary vessels. At 1 to 3 hr after cryotreatment, lectin UEA-1 binding was also positive in dilated endothelial cells of the frozen tissue as well as viable remaining neoplastic epithelia by freezing. ALP activity and UEA-1 binding disappeared in capillaries of cryonecrotic area in tumor tissues. Those findings suggest that biologic membrane changes in capillary endothelium of tumor stroma occur following cryotreatment.

Intratumoral ligation in the management of orofacial cavernous haemangiomas

After a short comment on the essential data concerning the pathology, clinical aspects and treatment of orofacial haemangiomas, the author presents his own method of treatment by intratumoral ligation. He describes the technical details by which interception of the blood supply to the haemangioma is achieved and also breakdown of the angiomatous mass into segments by the occlusion of vascular channels, thus completely interrupting the intratumoral blood flow. Obstruction of vascular lumina, endothelial atrophy, blood clot organization in the small diverticula between them and also subsequent fibrous hyperplasia which take the place of the vascular hyperplasia ensue. The method was used in 31 cases of cavernous haemangioma in different sites; the results, with follow-up periods of 1-8 years prove its efficacy.

Treatment of intraoral hemangiomas with nitrous oxide cryosurgery

Nitrous oxide cryosurgery, when applied efficiently, is shown to be both effective and consistent in the management of hemangiomas of the oral cavity. Continued use of this treatment modality is indicated.

Cryosurgery of major and minor salivary gland: a light microscopic evaluation in the Rhesus monkey

The minor salivary glands in the hard palate and the submandibular gland of the Rhesus monkey were subjected to a liquid nitrogen, direct-spray, one-cycle freeze. A 4-min freeze in the temperature range of -40 degrees C to -60 degrees C was used. The extent of tissue destruction was determined at intervals up to 1 year. Clinically relevant findings resulted and form the basis for subsequent studies by this group of investigators.

Six years' experience with cryosurgery in the oral cavity

Ninety selected patients with a benign or malignant lesion in the oral cavity were treated by cryosurgery. A clinical study was carried out during a 6-year period to investigate the value of cryosurgery as supplemental or substitute therapy. Good results have been obtained in the treatment of small to moderate, superficially situated angiomas. Cryotherapy has also been found to be satisfactory in the treatment of papillary hyperplasia of the palate. As symptomatic treatment we employed the freezing procedure to painful erosive lichen planus. Until now, a casual treatment has not been possible because of an unknown etiology. Used as symtomatic therapy, cryosurgery may be of some use in these cases, especially to relieve pain. Good results have been obtained in the treatment of oral leukoplakia. The pathologically changed mucous membranes could be completely eliminated in most of the cases without severe scar formation or impairment to functions. Cryosurgery for palliation was employed in 11 incurable tumors. Results have been disappointing. Twenty-one localized malignant neoplasms were treated by cryosurgery to cure. The tumor was completely destroyed in 67% of the cases.