title: Endoscopic transmucosal direct puncture sclerotherapy for management of airway vascular malformations.
abstract: OBJECTIVE
  To describe a multidisciplinary approach to the treatment of airway vascular malformations (venous or lymphatic) with direct suspension rigid laryngoscopy and direct puncture transmucosal bleomycin sclerotherapy injected under road-mapping fluoroscopic monitoring, supplemented by Dyna-computed tomography utilization.
  
  
  METHODS
  Case series.
  
  
  METHODS
  We performed a retrospective medical record and imaging review of four patients with venous malformations or lymphatic malformations located in the airway. Patients were treated with a combination of direct suspension laryngoscopy or rigid nasopharyngoscopy and image-guided direct puncture bleomycin sclerotherapy.
  
  
  RESULTS
  Two patients presented to our institution with extensive lymphatic malformation of the neck, parapharyngeal, and retropharyngeal spaces, and two presented with venous malformation of the nasopharynx and oropharynx. All patients were treated with multiple sclerotherapy and debulking procedures before undergoing combined direct transmucosal puncture bleomycin sclerotherapy guided by direct laryngoscopy or nasopharyngoscopy. All patients had complete resolution of disease while maintaining a safe airway.
  
  
  CONCLUSIONS
  A multidisciplinary approach to airway vascular malformations with a combination of endoscopy and direct puncture bleomycin sclerotherapy was demonstrated to be a safe and effective treatment in our patient cohort. Direct laryngoscopy and nasopharyngoscopy provide easy access to the nasopharynx, oropharynx, retro- and/or parapharyngeal spaces and larynx. Unlike traditional agents, bleomycin induces minimal edema and therefore is an ideal substance to treat airway lesions.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery (k.p.q.o.), Weill Cornell Medical College, New York, New York, U.S.A.|Department of Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery (k.p.q.o.), University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, the Netherlands.
authors.forename: Karin P Q
authors.initials: KP
authors.lastname: Oomen
authors.affiliation: Hyman Newmann Institute for Neurology and Neurosurgery-Center for Endovascular Surgery (s.p., j.t.f., a.b.), St. Luke's Roosevelt Hospital, New York, NY, U.S.A.
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Paramasivam
authors.affiliation: Vascular Birthmark Institute of New York, Department of Otolaryngology (m.w., t.o.), Lenox Hill and Manhattan Eye, Ear, and Throat Hospitals, New York, New York, U.S.A.
authors.forename: Milton
authors.initials: M
authors.lastname: Waner
authors.affiliation: Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Niimi
authors.affiliation: Hyman Newmann Institute for Neurology and Neurosurgery-Center for Endovascular Surgery (s.p., j.t.f., a.b.), St. Luke's Roosevelt Hospital, New York, NY, U.S.A.
authors.forename: Johanna T
authors.initials: JT
authors.lastname: Fifi
authors.affiliation: Hyman Newmann Institute for Neurology and Neurosurgery-Center for Endovascular Surgery (s.p., j.t.f., a.b.), St. Luke's Roosevelt Hospital, New York, NY, U.S.A.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Berenstein
authors.affiliation: Vascular Birthmark Institute of New York, Department of Otolaryngology (m.w., t.o.), Lenox Hill and Manhattan Eye, Ear, and Throat Hospitals, New York, New York, U.S.A.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: O
mesh_terms: D000293:Adolescent; D000328:Adult; D001761:Bleomycin / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007223:Infant; D007828:Laryngoscopy; D044148:Lymphatic Abnormalities / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012137:Respiratory System / Q000098:blood supply*; D015619:Respiratory System Abnormalities / Q000628:therapy*; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015911:Sclerotherapy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000175:diagnosis / Q000628:therapy*
chemical_list: D012597:Sclerosing Solutions; D001761:Bleomycin
keywords: Vascular malformations; airway; bleomycin; direct puncture sclerotherapy