Interstitial Nd:YAG photocoagulation for vascular malformations and hemangiomas in childhood.
BACKGROUND
Vascular malformations and cavernous hemangiomas are common in childhood. Although cavernous hemangiomas may resolve spontaneously, aggressive intervention is required when their growth could damage vital adjacent structures, such as the orbit, nose, or tongue.


OBJECTIVE
To evaluate the efficacy of interstitial Nd:YAG photocoagulation as an adjunct to intralesional and systemic corticosteroids for treatment of hemangiomas and vascular malformations that had failed to respond to other therapies.


METHODS
Prospective, nonrandomized trial.


METHODS
Two referral practices of facial plastic and reconstructive surgery in tertiary care, academic medical centers.


METHODS
Ten consecutive pediatric patients with either hemangioma or vascular malformation of the head and neck.


METHODS
Laser photocoagulation with an interstitial technique. The Nd:YAG fiber was introduced into the lesion via a 14-gauge angiocatheter needle, and the laser fiber was advanced as coagulation proceeded within the tissue.


METHODS
Decrease in the area of the target lesion, amount of energy applied, and number of treatments required to achieve reduction in size.


RESULTS
Long-term follow-up demonstrated regression of the lesion in all 10 patients with good cosmetic results. The range of reduction in size was 20% to 98%. No reexpansion of the lesions was noted after a mean follow-up of 13 months.


CONCLUSIONS
Interstitial photocoagulation of hemangiomas and vascular malformations is an effective treatment for carefully selected patients. When properly applied, this technique can achieve reduction in the size of these lesions without compromising cosmesis.
Clymer
M A
MA
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn 37232-2559, USA.
Fortune
D S
DS
Reinisch
L
L
Toriumi
D M
DM
Werkhaven
J A
JA
Ries
W R
WR
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D001165:Arteriovenous Malformations / Q000601:surgery*; D002406:Catheterization, Peripheral / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004867:Equipment Design; D005145:Face / Q000098:blood supply; D005153:Facial Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006391:Hemangioma / Q000601:surgery*; D006392:Hemangioma, Cavernous / Q000601:surgery*; D006801:Humans; D007223:Infant; D053685:Laser Therapy / Q000295:instrumentation*; D008297:Male; D010039:Otorhinolaryngologic Neoplasms / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones