Management of Superficial and Deep Vascular Malformations of the Maxillofacial Region

Abstract

Introduction: Haemangiomas and Vascular malformations of the maxillofacial region are formidable lesions causing considerable cosmetic deformity and grave functional debilitation. Technically, their surgical excision is difficult and challenging, fraught with complications like hemorrhage, incomplete excision, facial disfigurement and recurrence. This study has fashioned two techniques directed at permanently treating these lesions.

Aim: Evaluating the safety and long term efficacy of single session sclerotherapy with Polydocanol for superficial cutaneous / mucosal low flow vascular malformations; and of sclerothrombotic therapy with hot water as a neoadjuvant modality followed by surgical excision, for deeper high flow vascular malformations of the maxillofacial region.

Methods: Ten cases of Vascular Malformations of the maxillofacial region were treated. Of them, five were superficial, low flow lesions which were managed using intralesional instillation of Polydocanol alone without any surgical intervention thereafter; and the remaining five were deep, high flow lesions, which were treated first, by intralesional injection of hot water over two sessions, which was then followed by surgical excision of the lesion, which was carried out within the next 72 hours.

Results: Complete resolution of the lesions was achieved in all the cases.

Conclusion: Our results support the fact that single session sclerotherapy with Polydocanol may be considered as the primary modality in the treatment for superficial (cutaneous or mucosal) low flow vascular malformations. However, for deeper, high flow lesions, two sessions of intra lesional injection of hot water followed by surgical excision within 72 hours of the first injection, may be the treatment of choice.