title: Sclerotherapy for low-flow vascular malformations of the head and neck: A systematic review of sclerosing agents.
abstract: BACKGROUND
  Sclerotherapy has become the gold standard for the first-line therapy of most venous (VMs) and lymphatic malformations (LMs) of the head and neck. Numerous sclerosing agents are used to treat these low-flow vascular malformations; however, to date, it remains unclear which sclerosing agent is superior in terms of effectiveness and safety.
  
  
  METHODS
  In a systematic review of the literature (1995-present), we compare the effectiveness and complications of the sclerosing agents most commonly used for cervicocraniofacial VMs and LMs.
  
  
  RESULTS
  The literature search yielded 1155 articles, among which 36 (1552 patients) were included in the systematic review. The quality of evidence was low. Pingyangmycin, absolute ethanol, OK-432, ethanolamine oleate, bleomycin, polidocanol, doxycycline, and sodium tetradecyl sulfate (STS) were the most reported sclerosing agents. All agents seem effective, and the mean overall response varies from 71% to 100%. Complications occurred more frequently after ethanol sclerotherapy (18%), compared to other sclerosing agents (0-6%). Cellulitis and ulceration were encountered following sclerotherapy with most sclerosing agents, but skin necrosis was particularly observed after ethanol. Facial nerve paralysis occurred only after OK-432 (0.05%) and ethanol sclerotherapy (6%).
  
  
  CONCLUSIONS
  This systematic review could not identify a significantly superior sclerosing agent in terms of effectiveness, due to the low quality of the available evidence. Until stronger evidence is available, the difference in complication rates is potentially the deciding factor in the choice between sclerosing agents. As a significantly higher complication rate and more severe local complications were encountered after using absolute ethanol, we cannot recommend this agent for sclerotherapy of cervicofacial vascular malformations.
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: s.e.horbach@amc.uva.nl.
authors.forename: Sophie E R
authors.initials: SE
authors.lastname: Horbach
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands; Department of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Max M
authors.initials: MM
authors.lastname: Lokhorst
authors.affiliation: Department of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Peerooz
authors.initials: P
authors.lastname: Saeed
authors.affiliation: Department of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Claire M F
authors.initials: CM
authors.lastname: de Goüyon Matignon de Pontouraude
authors.affiliation: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Aniki
authors.initials: A
authors.lastname: Rothová
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Chantal M A M
authors.initials: CM
authors.lastname: van der Horst
mesh_terms: D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006257:Head; D006801:Humans; D008297:Male; D009333:Neck; D018570:Risk Assessment; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D012597:Sclerosing Solutions
keywords: Craniofacial; Head and neck; Lymphatic malformations; Sclerotherapy; Vascular malformations; Venous malformations