PubMed · 13465111
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I LIGHTERMAN. 1957. Macrocheilia.. https://doi.org/10.1016/0030-4220(57)90049-x
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OBJECTIVE: To map sites of occurrence of facial infantile hemangiomas and correlate these with pattern of tumor growth, clinical complications, and proximity to structural and developmental landmarks. DESIGN: A retrospective medical record review of 205 patients diagnosed with facial infantile hemangioma. SETTING: Arkansas Children's Hospital, Little Rock, a 250-bed teaching hospital affiliated with the University of Arkansas for Medical Sciences. PATIENTS: Based on their clinical photographs, 232 of the hemangiomas were mapped on a facial schematic. Each lesion was encoded with a number reflective of its location, and this number was shared by other lesions occurring at the same site. Frequencies of complicating ulceration and airway obstruction were determined by medical record review. RESULTS: Two patterns of tumor growth were evident among the hemangiomas analyzed: focal (177 lesions [76.3%]) and diffuse (55 lesions [23.7%]). The focal hemangiomas mapped to 22 sites of occurrence, all near lines of mesenchymal or mesenchymal-ectodermal embryonic fusion. The 55 diffuse hemangiomas showed a segmental tissue distribution and thus were designated as frontonasal (15 lesions [27%]), maxillary (19 lesions [35%]), or mandibular (21 lesions [38%]). Ulceration was 3 times more common in patients with diffuse hemangiomas (21 [51%] of 41) than in patients with focal hemangiomas (28 [17%] of 164). Airway obstruction was characteristic of diffuse mandibular hemangiomas. CONCLUSIONS: Facial infantile hemangiomas occurred in 2 distinct patterns of tissue involvement: a focal type with a tumorlike appearance and a less common diffuse type with a plaquelike appearance. The diffuse lesions were more likely to be complicated by ulceration or airway obstruction and showed a strikingly segmental distribution pattern. Focal hemangiomas, in contrast, showed a predilection for regions of embryological fusion.
BACKGROUND: Haemangiomas are common vascular lesions occurring in up to 10-12% of infants by 1 year of age. Typically, these lesions are treated expectantly unless complicated by haemorrhage, ulceration, infection, or compromise of adjacent vital structures. Ulceration is a particularly difficult problem because of associated pain, infection, haemorrhage, and subsequent scarring. MATERIALS AND METHODS: Seventy-eight children (54 girls, 24 boys) with ulcerated haemangiomas, from our vascular malformation clinic were enrolled in a prospective pulse dye laser treatment protocol from April of 1995 to November of 2001. The mean size of the ulcerated haemangiomas requiring treatment was 21 cm2. Lesions were treated with minimal debridement and the Cynosure pulse dye laser with a mean energy of 6.6 J, and a mean number of 173 pulses per treatment. Lesions were treated in a sequential pattern at 3-4 week intervals until cutaneous healing or involution of the haemangioma occurred. RESULTS: Seventy-one of the 78 patients (91%) responded to laser therapy alone with a mean number of 2.0 treatments. Six patients with very large haemangiomas required oral steroids (2-3 mg/kg/day) in combination with the pulse dye laser. After failing to improve on steroid therapy, two patients required the addition of interferon to their treatment protocol. The mean follow up time is 15 months with no sign of recurrent ulceration or regrowth of the haemangiomas in our study population. SUMMARY: Pulse dye laser therapy is a reasonably effective means of resolving the untoward complication of ulceration of haemangiomas. We report the largest series to date of ulcerated haemangiomas treated with this modality.
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