title: Transoral ultrasonic surgery of pharyngolaryngeal giant hemangioma after ethylene-vinyl alcohol copolymer (Onyx) embolization.
abstract: Cervico-mediastinal hemangiomas in adulthood are rare and slow-growing vascular tumors. The optimal treatment for giant hemangiomas is controversial. In asymptomatic cases, clinical observation is generally recommended.
  
  
  
  We report the transoral resection of a pharyngolaryngeal hemangioma (diameters of 44 × 56 × 39 mm) with tracheal involvement and mediastinal extension. Clinically, the patient had throat foreign body sensation, severe dyspnea and stridor. The hemangioma was first embolized by injecting ethylene-vinyl alcohol copolymer (Onyx) transorally, and then the obstructive aspect of the tumor was resected with a bipolar and ultrasonic clamp (ThunderBeat®, Olympus).
  
  
  
  Two months after surgery, nasal fiberendoscopy showed complete disappearance of the vascular mass at the larynx and hypopharynx, with a normal mobility of the larynx.
  
  
  
  In symptomatic patients, surgical reduction of large pharyngolaryngeal hemangiomas may be feasible by direct embolization and transoral ultrasonic resection. Both may provide an almost bloodless surgical field. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1239-1242, 2017.
authors.affiliation: Otorhinolaryngology Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Valls-Mateus
authors.affiliation: Angioradiology Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Luis San
authors.initials: LS
authors.lastname: Román
authors.affiliation: Angioradiology Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Macho
authors.affiliation: Pathology Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Alfons
authors.initials: A
authors.lastname: Nadal
authors.affiliation: Otorhinolaryngology Department, Hospital Clinic, Barcelona, Spain.|Faculty of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Bernal-Sprekelsen
authors.affiliation: Otorhinolaryngology Department, Hospital Clinic, Barcelona, Spain.|Faculty of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Vilaseca
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D004121:Dimethyl Sulfoxide; D004621:Embolization, Therapeutic / Q000379:methods*; D005500:Follow-Up Studies; D006392:Hemangioma, Cavernous / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D061214:Patient Safety; D010610:Pharyngeal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D011145:Polyvinyls; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D014139:Tracheostomy / Q000379:methods; D016896:Treatment Outcome; D059708:Ultrasonic Surgical Procedures / Q000379:methods*
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide
keywords: embolization; endoscopic surgery; ethylene-vinyl alcohol copolymer; hemangioma; transoral ultrasonic surgery