Milton Waner

Lenox Hill Hospital · Department of Otorhinolaryngology

Background The OVAMA (Outcome Measures for VAscular MAlformations) project determined quality of life (QoL) as a core outcome domain for evaluating treatment effect in vascular malformations. To correctly evaluate treatment effect on QoL, patient-reported outcome measures (PROMs) are needed that are responsive to changes. In children with vascular...

Vascular malformations are a group of rare congenital (present at birth) vessel anomalies. Mostly visible as a bumpy mass different in colour from normal skin, they can cause disfigurement of the face or body. Patients often experience pain, physical impairment, bleeding, and psycho‐social problems, leading to an overall poor quality of life. Thus,...

血管畸形是一组罕见的先天性(出生时存在的)血管畸形。它们大多可见,为与正常皮肤颜色不同的凹凸不平的肿块,可导致面部毁容或身体的外观缺陷。 患者经常出现疼痛、身体损伤、出血和心理社会问题,导致其总体生活质量较差。因此,治疗的一个主要目标是提高他们的生活质量。生活质量是通过由患者填写的调查问卷来衡量的。 为了确定患者的生活质量在治疗后是改善了还是恶化了,调查问卷要能够探测出随着时间的推移发生的变化,这是至关重要的。从来没有人研究过生活质量调查问卷是否可以探测出血管畸形患者中的变化。因此,无法评估目前的治疗是否真的改善了这些患者的生活质量。 这项来自荷兰和美国的研究旨在查明两个广泛使用的生活质量调查问卷“SF‐36”和“Skindex‐29”是否能够探测出血管畸形患者中的变化。67 名患者在两个时...

Objectives: Arteriovenous malformations (AVM) are the most troublesome vascular malformations to deal with. They tend to behave like low-grade malignancies with infiltrative and disruptive growth. Crucially, the clinical course of an AVM that has been improperly managed is usually characterized by a recurrence that is much more aggressive than the...

Introduction: The OVAMA (Outcome measures for vascular malformations) project determined quality of life (QoL) as a core outcome domain for patients with vascular malformations. In order to measure how current therapeutic strategies alter QoL in these patients, a patient-reported outcome measurement (PROM) responsive to changes in QoL is required....

Background:. Soft-tissue loss is expected after resection of large vascular lesions. Autologous fat transfer improves asymmetries; however, systematic outcomes are not previously described for vascular anomaly reconstruction. Methods:. Retrospective chart review from 2012 to 2015 included patients receiving autologous fat transfers for soft-tissue...

Vascular malformations are often found inside the orbit. Isolated venous malformations (frequently misnamed as cavernous hemangiomas) are the most frequent among these. However, also lymphatic and arteriovenous malformations can affect the orbit. The complex anatomy of the orbit and the fact that its content easily suffers from compartmental syndro...

The surgical management of facial infantile hemangiomas presents a unique challenge. The aim of the surgeon should be to remove the hemangioma and to restore normal facial features. Each of the facial zones has its own special features and challenges. The surgeon should remember that the child started out with normal anatomy and that as the hemangi...

Lymphatic malformations (LMs) occur in 2.8 to 5 per 100,000 live births. Most involve the head and neck and they are equally common in men and women. They are developmental anomalies of unknown cause, although recent evidence suggests that an upregulation of the mammalian target of rapamycin (mTOR) pathway may be a causal factor leading to the over...

Vascular malformations are congenital anomalies of the vascular and/or lymphatic system that affect the head and neck region. The most common treatment options are sclerotherapy, laser therapy, surgery, and embolization. Because vascular malformations are variable in type, size, extent, and location, it is a challenge to select methods for evaluati...

Infantile hemangiomas (IH, hemangiomas) of the nose comprise 15% of head and neck hemangiomas. Nasal hemangiomas are important because of their prominent location on the face and their liklihood to leave a disfiguring residuum after involution. Early treatment with propranolol is advocated and for those that fail to respond, surgical resection thro...

Purpose: Vascular lip anomalies include infantile hemangiomas, venous malformations, and arteriovenous malformations. Surgical management can be complicated by alterations in horizontal length, vertical height, and lip thickness from the underlying pathology. Additional reconstructive challenges include preservation of oral continence, vermillion...

Importance: The current standard of treatment for infantile hemangiomas (IHs) involves initial observation for regression throughout infancy and childhood, with or without medical management with β-blocker medications. Approximately 50% of the lesions respond almost completely to this regimen. However, the remaining 50% of the lesions, especially...

BACKGROUNDA percentage of patients with capillary malformation (CM) develop soft tissue hypertrophy, bony hypertrophy, and/or nodule formation.OBJECTIVE To determine the incidence, age of onset, anatomic distribution of soft tissue/bony hypertrophy, and nodule formation in patients with untreated CM.METHODSA retrospective medical records review of...

Infantile hemangioma (IH) is the most common tumor of the pediatric age group, affecting up to 4% of newborns ranging from inconsequential blemishes, to highly aggressive tumors. Following well defined growth phases (proliferative, plateau involutional) IH usually regress into a fibro-fatty residuum. Despite the high prevalence of IH, little is kno...

Background: Changes in the composition of the extracellular matrix (ECM) occur between the proliferating and involuted phases of infantile hemangiomas (IH), and are associated with angiogenic growth. We examined the composition of the ECM in proliferating and involuted IHs and assessed correlations between the composition of the ECM and whether th...

Scalp infantile hemangiomas (IHs) are usually focal lesions that can be both disfiguring and may lead to complications such as ulceration and bleeding. The clinical features of scalp IHs have not been previously studied. This study aims to identify the clinical characteristics associated with scalp IH, the indications for surgical intervention, and...

Objectives/HypothesisTo describe a multidisciplinary approach to the treatment of airway vascular malformations (venous or lymphatic) with direct suspension rigid laryngoscopy and direct puncture transmucosal bleomycin sclerotherapy injected under road-mapping fluoroscopic monitoring, supplemented by Dyna-computed tomography utilization.Study Desig...

VASCULAR LESIONS OF THE HEAD AND NECK: DIAGNOSIS AND MANAGEMENTM S Persky, M Waner, F Blei, A BerensteinThieme Publishers, 2014 ISBN 978 1 60406 059 1 eISBN 978 1 58890 282 3 pp 168 Price €79.99 US $99.99 - Volume 129 Issue 4 - L M Flood

Purpose: Bleomycin is an antibiotic medication that inhibits the synthesis of DNA, RNA, and proteins and is now used in a variety of medical conditions including vascular anomalies. The aim of this study was to evaluate the clinical efficacy of transmucosal intralesional injection of bleomycin in the management of tongue lymphatic malformations. Me...

Both infantile hemangiomas and vascular malformations can involve the upper airway. Each of these lesions has a characteristic anatomical distribution pattern and clinical presentation and any one of them may lead to airway obstruction. Airway infantile hemangiomas, the most common, may be focal or segmental in their distribution. Focal infantile h...

When considering the treatment of infantile hemangiomas, several questions must be answered. Whether or not to treat, when to treat, and how to treat. During the past decade, the paradigm for the treatment of hemangiomas has changed. Propranolol has become the first line of therapy. However, there are instances where surgery and or laser treatment...

Vascular lesions constitute up to 10–15 % of all orbital tumors (Rodgers R, Grove SA (2000) Vascular lesions of the orbit. In: Albert D, Jakobiec F, Azar D et al. (eds) Principles and practice of ophthalmology, 2nd edn, vol 4. WB Saunders Company, Philadelphia, pp 3144–3154). The shape, color, and invasiveness differ within each group: from bright...

Infantile hemangiomas are well known for their rapid growth during the first 6 to 9 months of life, followed by a spontaneous but slow involution. The standard of care is to treat these lesions at an early age with propranolol to expedite the involution process; however, surgery still remains an active component in the management. Medical treatment...

Importance Port-wine stains (PWSs) are common congenital cutaneous capillary malformations. A somatic GNAQ mutation was recently identified in patients with sporadic PWSs and Sturge-Weber syndrome. However, subsequent studies to confirm or extend this observation are lacking.Observations We report a long-standing, unilateral facial PWS of a man i...

Background: The majority of patients with capillary malformations (port-wine stains) develop soft-tissue and bony hypertrophy leading to gross facial asymmetry and functional deficits in vision, breathing, speech, and feeding. The authors describe and illustrate a surgical approach for the treatment of these malformations with restoration of facia...

The molecular pathophysiology of venous malformations (VMs), which are a type of vascular malformation, is poorly understood. Until now, it is known that VM lesions are related to the process of angiogenesis. Because angiogenesis is induced under hypoxic conditions, hypoxia is thought to be important in VM lesion formation. Therefore, we examined t...

Infantile hemangiomas (IHs) are the most common benign tumors of infancy and occur with greater than 60% prevalence on the head and neck. Despite their prevalence, little is known about the pathogenesis of this disease. Given the predilection of hemangioma incidence on the face and its nonrandom distribution on embryological fusion plates, we postu...

The present invention describes stem cells and progenitor cells derived from hemangiomas, including testing of angiogenic inhibitors using these cells. The invention as described is useful in providing a process to culture and propagate hemangioma stem cells and generate xenograft models to develop treatments for infantile hemangiomas and other typ...

To develop a more reliable methodology for monitoring the facial nerve in surgeries of vascular malformations where the extracranial segment of the nerve is at risk. Our methodology comprises: (1) preoperative mapping to identify the anatomical location of the nerve branches, (2) continuous intraoperative monitoring of the compound muscle action po...

Purpose: Vascular anomalies comprise malformations, hemangiomas, and rare tumors. The commonality among these lesions is their origin in vascular endothelia. Most occur sporadically, but occasional inheritance is observed and thus allows genetic research and insight into etiology. This review highlights those vascular anomalies in which genetic in...

Importance: Infantile hemangiomas (IHs) are the most common tumors of infancy. Objectives: To describe the patterns of occurrence of lip IHs and correlate these findings with patterns of anatomical distortion and predictable clinical outcomes and to describe the surgical management of these lesions. Design: A retrospective medical record revie...

Objectives/HypothesisTo characterize the anatomic distribution of lymphatic malformations of the upper airway.Study DesignCase series with chart review.SettingTertiary care referral center specializing in the diagnosis and treatment of vascular anomalies.MethodsA 7-year (2004-2011) retrospective chart review of patients with lymphatic malformations...

Background: Infantile hemangioma (IH) clearance may be slow or incomplete in response to pulsed dye laser (PDL) or propranolol alone. Objectives: To evaluate whether IH treated with PDL and propranolol displayed more rapid and complete clearance than IH treated with propranolol alone. Materials and methods: Retrospective review of facial-segme...

Purpose: Infants with orbital hemangiomas and vascular malformations often develop expanded orbits or regional hyperostosis. Treatment in these cases depends, in part, on the stage of orbital development at the time of intervention; yet, orbital development with respect to age is not well-known. The authors sought to determine the rate of orbital...

Surgery is one of the modalities used to treat vascular lesions. Its role is to act in concert with interventional radiology and the various pharmacologic agents. The role of surgery in patients with hemangiomas is limited to nonresponders to propranolol, complications, and eyelid lesions. Corrective surgery would also normalize facial distortion a...

Objective: The objective of the study was to report our experience in a rare series of treated symptomatic slow-flow vulvar venous malformations (VVMs) using a staged, multidisciplinary approach. Study design: Consecutive patients with symptomatic lesions treated over a 7 year period (2005-2012) were followed up for technical success, resolution...

Infantile hemangiomas (IH) are the most common benign tumors of infancy. The typical clinical course consists of rapid growth during the first year of life, followed by natural and gradual involution over a multi-year time span through unknown cellular mechanisms. Some tumors respond to medical treatment with corticosteroids or beta-blockers, howev...

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 con...

To analyze the operative benefit of preoperative sclerotherapy of facial venous malformations and assess long-term patient outcome. Preoperative sclerotherapy was performed in 24 consecutive patients referred before resection of facial venous malformation. Pretreatment imaging was reviewed for malformation dimensions (length, width, and height), an...

Many children with cervicofacial lymphatic malformations have facial skeletal abnormalities. This study qualitatively and quantitatively evaluated these bony mandibular abnormalities. Retrospective chart review. Patients with craniofacial lymphatic malformations presenting to a vascular anomalies center during a 2-year period were included. An age-...

Diabetes mellitus is characterized by either the inability to produce insulin (type 1 diabetes) or as insensitivity to insulin secreted by the body (type 2 diabetes). In either case, the body is unable to move blood glucose efficiently across cell membranes to be used. This leads to a variety of local and systemic detrimental effects. Current treat...

A healthy 4-month-old female infant had experienced progressive painless protrusion of the right eye for 3 months. Examination revealed axial proptosis of the right globe along with fullness of the eyelids (Figure 1A). A relative afferent pupillary defect was not detected. Magnetic resonance imaging revealed a predominantly intraconal mass replacin...

To report our experience in and our surgical technique of treating vascular anomalies of the buccofacial region using an intraoral buccomucosal flap approach. Retrospective medical record review and illustration of a specific surgical procedure. Academic tertiary care center. Thirty-two patients with vascular anomalies of the buccofacial region who...

To characterize the anatomic distribution of segmental hemangiomas of the larynx and to describe indications for treatment modalities. Retrospective chart review. We performed a retrospective chart review of patients with cutaneous hemangiomas at a tertiary care center over a 4-year period. Only patients with upper airway hemangiomas were studied....

The pathogenesis for benign tumorigenesis in hemangiomas is unknown. Oncogene proteins may be influential in this process. SKI proteins have been previously described in various malignancies. We investigated the differential expression of the SKI (sarcoma viral oncogene) protein in hemangiomas. Prospective basic science study. Paraffin-embedded hem...

Vascular malformations of the conjunctiva are symptomatically distressing and surgically challenging. Because their expansive nature necessitates broad conjunctival sacrifice in some cases, epithelial reconstitution may be the best way to avoid symblepharon formation. Amniotic membrane grafts have been useful for conjunctival reconstruction after e...

Infantile hemangiomas (IHs) are the most common benign vascular tumors of childhood. IH of "segmental" morphology, are clusters of hemangiomas with a configuration involving a broad anatomic territory of skin. They are the least common of all types and generally larger than regular hemangiomas, morphologically characterized as plaque-like lesions....

To study a new surgical approach to pediatric nasal hemangiomas and the need for early surgical intervention. Childhood hemangiomas are most common in the head and neck area. They can result in life-altering situations by causing airway obstruction, disfigurement, ulceration, and other adverse effects. A retrospective study of 44 consecutive patien...

Problem Infantile hemangiomas have a well-known distinct proliferative phase characterized by rapid proliferation of capillaries, followed by an involuting phase characterized by spontaneous and steady regression of the tumor. Histologically, proliferating hemangiomas are composed of masses of compact capillaries lined by plump endothelial cells wi...

We present neuroradiologic findings in 17 patients with posterior fossa malformations, hemangiomas, arterial anomalies, cardiac defects, eye abnormalities, and sternal or ventral defects (PHACES) association and identify those at highest risk of central nervous system (CNS) structural, cerebrovascular, and neurodevelopmental abnormalities. Patients...

A consecutive group of 50 patients requiring pectoralis major myocutaneous flap reconstruction after head and neck surgery is presented. The tissue defects for reconstruction are divided into five groups to identify any defects in which the flap is more likely to be at risk of complication. Other risk factors such as preoperative radiotherapy, chem...

We have developed a conductive interstitial thermal therapy (CITT) device to precisely and reliably deliver controlled thermal doses to the surgical margins at the cavity site following tumor resection, intraoperatively. The temperature field created by CITT ablation of a perfused tissue was modeled with a finite element package Femlab. The modelin...

Neodymium:yttrium aluminum garnet (Nd:YAG) laser therapy for venous malformations (VMs) of the head and neck is a rather new therapeutical option in addition to sclerotherapy and surgery. One hundred forty-six patients (age 2 months to 77.5 years) with VMs in the head/neck (localized, diffuse, and multifocal) were retrospectively analyzed with rega...

Pulsed dye lasers (PDL) are the standard of care in the treatment of cutaneous vascular disorders such as the port-wine strains or hemangiomas of infancy. Nonetheless, there is still uncertainty regarding the specific laser parameters that are likely to yield optimal clinical outcomes. Using mathematical modeling, we explain and associate clinical...

The surgical excision of vascular anomalies is often accompanied with significant perioperative bleeding. Novel hemostatic agents, including recombinant factor VIIa (rVIIa), have been shown to reduce bleeding in hemophilia and trauma patients along with decreasing blood loss during various surgical procedures. The role of rVIIa during excision of v...

To examine our vascular anomalies team's experience with tongue arteriovenous malformations (AVM) with specific emphasis on the spectrum on disease and surgical management. Retrospective chart review of 11 patients (10 female, 1 male), discovered from 1997 to 2005 with histological, radiographic, and clinical characteristics consistent with tongue...

Vascular tumors of infancy and childhood represent a number of clinicopathologically distinct entities for which precise histopathological diagnosis is often essential in determining effective therapeutic approach. Unfortunately, pathologists and clinicians alike have traditionally tended to lump these tumors, in addition to small vessel vascular m...

Pulsed dye laser (PDL) has been reported to be safe and effective in the management of superficial hemangiomas of infancy. We report 12 patients with hemangiomas with complications following PDL. Records of patients with hemangiomas and a known adverse outcome following PDL were reviewed. All were treated early (age range: 5 days to 4 months), and...

Laser tissue interaction can be modeled by applying the finite element method. Using the high spatial precision of that approach (0.1 μm), the photon distribution and the thermal action even in small vessels of port wine stains (PWS) can be visualized. By using a two-dimensional histology-like cut into the skin, a virtual image of temperature can b...

Laser treatment of venous malformations is a major challenge because of the large variations in skin pigmentation, anatomic location, and vessel size and depth. To determine the safety and effectiveness of electro-optical synergy, a new technology that combines the 900 nm diode laser with radiofrequency current for the treatment of facial venous ma...

The popularity of laser-assisted hair removal has grown rapidly since April 3, 1995 when the Food and Drug Administration approved the introduction of the first hair removal laser system. Lasers with wavelengths in the red and infrared portion of the electromagnetic spectrum are most often used for hair removal because they effectively target melan...

The port-wine stain (PWS) is a congenital cutaneous venulocapillary malformation of unknown pathogenesis. Many patients with facial PWS develop thickening with cobblestoning and nodularity during adult life. The histologic correlates of this maturational change are poorly documented and its mechanisms remain unclear. In this case study we present n...

Recombinant factor VIIa (rFVIIa) has become available for treating people with hemophilia with inhibitors who experience bleeding or require surgery. It has become apparent that rFVIIa is useful in controlling bleeding in a variety of clinical situations. This review attempts to collate and summarize the nonhemophilia applications of rFVIIa. The th...

The therapeutic approach to haemangiomas has changed slightly in recent years, moving from a generally conservative attitude to a more aggressive one in some cases. Chronic unaesthetic alterations that might be caused by haemangiomas, psychosocial traumas that can be caused during childhood, together with a better understanding of the behaviour of...

The use of the indications of the laser in treating vascular malformations and infantile haemangiomas is based on the theory of selective photothermolysis, in which the oxyhaemoglobin is the target chromophore on which the light of the laser acts, thus avoiding damage to neighbouring tissues. The pulsed dye laser is the most employed and at present...

Monte Carlo (MC) simulations of light-tissue interactions and analytical solutions for the diffusion approximation theory have been used to determine the optimal laser wavelength and radiant exposure to treat port-wine stains (PWS). Both approaches suggest that optimal parameters are a wavelength of 585 or 595-nm with pulse times of 0.45-20 millise...

Congenital vascular lesions are classed as hemangiomas, vascular malformations, or vascular tumors according to their histology and etiology. The majority of hemangiomas are benign and often involute before the child reaches the age of 12. Severe hemangiomas and vascular malformations were historically viewed as effectively inoperable due to the hi...

El planteamiento terapéutico ante los hemangiomas ha cambiado ligeramente estos últimos años, pasando de mantener una actitud general conservadora a ser más agresivos en algunos casos. Las alteraciones inestéticas crónicas que pueden originar los hemangiomas, el trauma psicosocial que pueden desencadenar en la niñez, junto con un mejor conocimiento...