title: Hemangiomas of the nasal tip: an approach to a therapeutic challenge.
abstract: OBJECTIVE
  Hemangiomas of the nasal tip (HNT) are commonly described as "Cyrano" or "Pinocchio nose". They may cause significant aesthetic and functional impairment. It is still controversial how and when HNT should be treated. The risk of severe complications like irreversible contour deformities, growth disturbance, ulcerations, and nasal obstruction may obligate a therapeutic intervention. The aim of this study is to overview and to analyze different therapeutic approaches which were practiced over the last decade in two specialized centers.
  
  
  METHODS
  This is a retrospective study which includes the analysis of demographic parameters, extent of the lesion, therapeutic interventions, outcome, and follow-up interventions. The analysis includes a blinded evaluation of photographic series for evaluation of the extension at the time of presentation and of the final outcome.
  
  
  RESULTS
  Twenty-three children with HNT were analyzed who presented from 04/01/1998 to 03/31/2009. The age at presentation ranged from 1 to 63 months. On 6 patients (26%) conventional surgery was performed, 6 (26%) were treated with Nd:YAG laser, 6 (26%) were only observed, in 3 cases (13%) cryotherapy and in 2 patients (9%) treatment with Propranolol was performed. The results were evaluated between 9 months and 10.5 years after treatment (mean: 35.5 months). Limited lesions which were only observed showed a good tendency of regression. Significant wound healing disturbance and scar formation was observed after Nd:YAG laser therapy. Secondary rhinoplasty in adulthood was recommended to two patients.
  
  
  CONCLUSIONS
  Limited lesions do not require therapy. The results with Propranolol are encouraging. Laser- and cryo-therapy have to be critically reevaluated. Treatment of choice for lesions that are not suitable for beta blockers and residual disease is conventional surgery.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of Marburg, Germany. eivazi@med.uni-marburg.de
authors.forename: B
authors.initials: B
authors.lastname: Eivazi
authors.forename: H J
authors.initials: HJ
authors.lastname: Cremer
authors.forename: C
authors.initials: C
authors.lastname: Mangold
authors.forename: A
authors.initials: A
authors.lastname: Teymoortash
authors.forename: S
authors.initials: S
authors.lastname: Wiegand
authors.forename: J A
authors.initials: JA
authors.lastname: Werner
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D002675:Child, Preschool; D002921:Cicatrix / Q000209:etiology; D017679:Cryotherapy; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006391:Hemangioma / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053685:Laser Therapy; D053844:Lasers, Solid-State; D008297:Male; D009666:Nose / Q000601:surgery*; D009669:Nose Neoplasms / Q000628:therapy*; D011433:Propranolol / Q000627:therapeutic use; D012189:Retrospective Studies; D014945:Wound Healing
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol