Vascular malformations of the head, face, and neck” is often used as a general term and includes a number of different abnormalities that usually occur in children or young adults. They may appear as a cosmetic blemish or mass, or may come to attention by causing a disturbance of function. Vascular malformations have received different names depending on the cause:
A hemangioma is a benign blood vessel tumor appearing within the first month of life. The tumor may grow rapidly, disproportional to the child’s growth, during what is known as the proliferative phase, and usually reaches a maximum size when the child is between one and three years of age. The hemangioma then begins to get smaller during the involutive phase.
Eventually, in most cases, all that remains is some excess fatty fibrous tissue (like wrinkled skin) that can easily be removed by a plastic surgeon. Generally, hemangiomas only require treatment early in life if they bleed or result in some obstruction of normal function, for example the inability to close the eye. Embolization of the hemangioma may be performed to stop bleeding or preserve function.
A true vascular malformation, on the other hand, is usually present at birth, grows proportionally with the child, does not go through a proliferative or involutive phase, and does not disappear. Vascular malformations may become apparent later in life as blood flow increases through this abnormal connection between arteries and veins. They may cause cosmetic deformities of the head and neck, face and facial bones, mouth, tongue, nose or eyes, and interfere with normal function in these areas. At times the lesion can result in severe or uncontrollable bleeding.
Vascular malformations may be influenced by hormonal changes occurring during puberty and pregnancy. As opposed to hemangioma, most vascular malformations will require treatment.
Venous vascular malformations, another type of vascular anomaly of the head, neck and face, appear as a bluish discoloration of the skin, lips or inside of the mouth. They tend to increase in size with effort such as crying, pushing or other maneuvers that increase pressure in the venous system. While they can be disfiguring, they usually are not life-threatening. The treatment of venous vascular malformation has markedly advanced with the use of fluoroscopic (viewed by x-ray) guided sclerotherapy.
Sclerotherapy refers to the direct injection of a substance that will produce scarring within the vascular lesion. Different substances (sclerosing agents) have been used to achieve this goal.
A multidisciplinary team of specialists, including endovascular neuroradiologist, plastic and reconstructive surgeons, oral and maxillofacial surgeons, psychologists and other specialists] is frequently required to treat these complex problems.
