Intralesional steroid injection for proliferative parotid hemangiomas
To evaluate the efficacy of proliferative phase intralesional steroid injections in the treatment of parotid hemangiomas.
Retrospective analysis of pediatric patients with parotid hemangiomas treated with intralesional steroid injections during the proliferative phase.
Vascular Anomalies Center, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USA.
Twenty-one pediatric patients, ages 4-39 months.
Between 2001 and 2006, 21 patients received steroid injections for 23 parotid hemangiomas (bilateral in 2 patients). A total of 1-3 injections over the first year of life were given at 6-25 week intervals.
Main outcome measures included softening, decreased growth rate, and/or decrease in size. After injection, achievement of outcome measures occurred with all lesions. No incidence of tissue atrophy or facial nerve injury was seen. Four of 21 (19%) patients developed failure to thrive (FTT).
Parotid hemangiomas can be effectively controlled with proliferative phase intralesional steroid injections. Injections may limit the need for future extensive surgery. Further prospective randomized trials are needed to support these claims. Failure to thrive may be a potential complication of intralesional steroid injection. Endocrine/growth monitoring should be considered when treating with intralesional steroids.
Available from: Gresham T Richter
- "Each treatment option has limited therapeutic benefit with its own side-effect profile and risks (Bauman et al, 1997; Adams, 2001; Goyal et al, 2004; Deboer and Boston, 2008). Intralesional steroid therapy, often requiring multiple injections, is an effective and safe first-line option for nasal tip and deep parotid lesions in the proliferative phase to control accelerated growth and terrible esthetic consequences (Buckmiller et al, 2008; Simic et al, 2009). Massive hemangiomas, liver disease with enzyme dysfunction, airway lesions, segmental disease, and periorbital involvement often require systemic therapy to control progression and devastating functional outcomes. "
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ABSTRACT: Oral Diseases (2010) 16, 405–418
Vascular anomalies are congenital errors in vascular development. They frequently involve the head, neck, and oral cavity. Subdivided into vascular tumors (hemangiomas) and vascular malformations, vascular anomalies remain poorly understood. However, growing interest and recent advances in the diagnosis, management, and molecular characterization of these lesions are improving treatment strategies. The role of the multidisciplinary team cannot be overstated. This review provides both basic and up-to-date knowledge on the most common vascular anomalies encountered by physicians and practitioners. Because treatment options for vascular anomalies are widely variable and often debated, this report aims to provide a comprehensive approach to these lesions based upon current concepts and practical clinical experience.
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ABSTRACT: The purpose of this study was to evaluate the efficacy of bleomycin A5 (pingyangmycin) plus dexamethasone for control of growth in infantile parotid hemangiomas.
We reviewed and analyzed the data of 31 cases undergoing therapy of intralesional injection with small-dosage and low-concentration bleomycin A5 plus dexamethasone between June 2004 and October 2007. Clinical manifestations, image characteristics, and therapeutic outcomes were reviewed. The therapeutic outcomes were evaluated by physical examination, photographs, and Doppler ultrasonography. The follow-up was from 6 months to 3 years after ending treatment.
Twenty-five patients (80.6%) had a response rate greater than 90% reduction in tumor size. Three patients (9.7%) had a response rate between 75% and 90% reduction in tumor size. Another 3 patients (9.7%) had a response rate between 50% and 75% reduction in size. No patients had less than a 50% response rate. There was no recurrence, allergic reaction, pulmonary fibrosis, fever, or other complication during or after the course of treatment.
The controlling therapy with small-dosage and low-concentration bleomycin A5 plus dexamethasone can treat the parotid hemangiomas of infants effectively, especially for lesions in the early phase and proliferative phase. Early control and long-term observation are the key aspects of treatment.
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ABSTRACT: Infantile hemangiomas represent one of the most common childhood tumors. The authors have previously demonstrated that the most appropriate management for such tumors is a nonoperative approach. Some authors have recently advocated surgical management as the primary treatment. Medical treatment such as steroids or interferon therapy has also been proposed. Definitive treatment for infantile parotid gland hemangioma remains controversial.
In the retrospective study portion of this article, the authors reviewed the last 400 charts of children with hemangiomas managed at the Montreal Children's Hospital over the past 40 years. Twenty patients with parotid hemangiomas were identified. In the literature review portion, the Ovid MEDLINE and PubMed databases were used to retrieve all published original articles on the management of parotid hemangiomas from 1950 to December of 2008.
All of the authors' patients underwent successful nonoperative management, with 100 percent resolution of their parotid hemangiomas within 2 years of diagnosis, with an average follow-up time of 8.6 +/- 5.7 years. There were no complications of any of the treatments. The literature review retrieved a total of 413 patients in 12 original articles and four case reports. Management included observation and medical (steroid or interferon) and/or surgical treatment. Complications included failure to thrive, scarring, facial nerve palsy, and death.
The authors have shown that nonoperative therapy resulted in regression and involution of infantile parotid hemangiomas with no major complications.
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