Current Treatment of Parotid Hemangiomas

The Laryngoscope (Impact Factor: 2.03). 08/2011; 121(8):1642 - 1650. DOI: 10.1002/lary.21358
Source: PubMed

ABSTRACT Objectives/Hypothesis:Parotid hemangiomas are the most common salivary gland tumors in children. Their treatment has posed a challenge because of the lesions' expansive growth, resistance to treatment, and relationship with the facial nerve. Various treatment modalities have been attempted, and promising results have been achieved with surgical resection alone or in conjunction with endovascular sclerotherapy. Recently, bleomycin and oral propranolol have been introduced, and the results thus far are promising. Here we elucidate the treatment options and propose a treatment algorithm for parotid hemangiomas.Study Design:Retrospective chart review.Methods:We conducted a retrospective chart review of patients from 2004 to 2009 with hemangiomas involving the parotid gland. We included 56 patients and relevant parameters.Results:Seventy percent of patients were female. The female-to-male ratio was 2.3 to 1. Thirty-nine percent had unilateral parotid hemangiomas, 12.5% had cutaneous segmental hemangiomas. All 22 patients who underwent systemic steroid therapy responded initially, but 68% of these rebounded after cessation of therapy. Sixteen patients (29%) underwent surgery with excellent results (facial symmetry, restoration of contour, preserved facial nerve function). Seven (44%) patients received sclerotherapy 24 to 48 hours before surgery, and five (8%) received endovascular sclerotherapy alone. Ten patients were treated medically with oral propranolol. Eight of 10 had significant shrinkage of the lesion within the first month of treatment. There were no reported side effects.Conclusions:Multiple treatment regimens have been used to successfully treat parotid hemangiomas. Although propranolol is a recent addition, it seems most promising. Further evaluation is warranted.

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    ABSTRACT: To systematically review the literature evaluating efficacy and adverse events of propranolol treatment for infantile hemangiomas, we searched the MEDLINE and Cochrane databases for all studies examining the response of infantile hemangiomas (IHs) to propranolol published between June 12, 2008, and June 15, 2012. Forty-one studies with 1,264 patients were included; 74% of patients were female and approximately 30% had received other treatments before propranolol. Propranolol was initiated at a mean age of 6.6 months at a mean dose of 2.1 mg/kg/day and for a mean treatment duration of 6.4 months. The response rate for patients with IHs treated with propranolol was 98% (range 82%-100%), with response rate defined as any improvement with propranolol. Treatment response rates were comparable for studies evaluating IHs at specific sites, such as periorbital IHs. Studies that followed patients after treatment completion reported IH rebound growth in 17% of patients. There were 371 adverse events reported in 1,189 patients. The most common adverse events were changes in sleep (n = 136) and acrocyanosis (n = 61). Serious adverse events were rare, with reports of symptomatic hypotension in five patients, hypoglycemia in four, and symptomatic bradycardia in one. This systematic review of 1,264 patients treated with propranolol for IHs showed a high rate of efficacy and a low rate of serious adverse events.
    Pediatric Dermatology 03/2013; 30(2):182-91. DOI:10.1111/pde.12089 · 1.52 Impact Factor
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    ABSTRACT: Hemangiomas account for 0.4-0.6% of all tumors of the parotid gland and most of them occur in children, nevertheless in adults hemangiomas are very rare. We report the case of a 62 year old woman with a mass in the parotid right tail associated with fluctuating swelling episodes unrelated to meals and with a slowly progressive growth. The provisional diagnosis was a pleomorphic adenoma, so a right superficial parotidectomy was performed. During surgery, the macroscopic appearance makes suspect a vascular lesion. The histopathological result was a cavernous hemangioma. The classic clinical presentation of a parotid hemangioma is an intraglandular mass associated or not with skin lesions characterized by reddish macules and/or papules, and a vibration or pulsation when palpating the parotid region. In imaging tests, phleboliths could be observed which are very suggestive of a hemangioma or a vascular malformation. In the absence of these signs, the diagnosis could be difficult, particularly in an adult due to its low prevalence, with about 50 cases reported worldwide. However a hemangioma should be considered in the differential diagnosis of parotid tumors in adults. Key words:Cavernous hemangioma, parotid gland, superficial parotidectomy, pleomorphic adenoma.
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    ABSTRACT: Abstract Conclusions: Parotidectomy remains the mainstay of treatment for both benign and malignant lesions of the pediatric parotid gland. Adjuvant radiation therapy should be used judiciously in pediatric patients due to the higher risk of post-irradiation complications. Objective: The purpose of this study was to define the incidence and treatment of pediatric parotid tumors, and to determine what factors are useful in the management of these lesions. Methods: From June 2002 to June 2012, 22 patients ≤18 years of age with parotid mass were treated at Chonnam National University Hospital. Information on patient characteristics, clinical and histopathologic tumor characteristics, and treatment modalities and their results was obtained from the medical records. Results: The 22 patients comprised 11 males and 11 females. Eighteen patients had a benign tumor and four patients had a malignant tumor. The most common benign tumor was pleomorphic adenoma (63.6%) and the most common malignant tumor was mucoepidermoid carcinoma (9%). The most common treatment was superficial parotidectomy. Three patients required adjuvant radiotherapy. None of the patients had major complications or facial nerve palsy.
    Acta oto-laryngologica 08/2013; DOI:10.3109/00016489.2013.822554 · 0.98 Impact Factor

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