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Case Report Plastic and Aesthetic Research

Management of extensive intraparotid

vascular malformation: a case report

Katerina Anesti , Zachary Moaveni , Heng-Yi Wu 3
1
2
1 Department of Plastic and Reconstructive Surgery, St. Andrew’s Centre, Chelmsford, UK.
2 Department of Plastic and Reconstructive Surgery, Counties Manukau DHB, New Zealand.
3 Waikato District Health Board, Private Bag 3200, Hamilton 3240, New Zealand.
Address for correspondence: Miss. Katerina Anesti, Department of Plastic and Reconstructive Surgery, St. Andrew’s Centre, Chelmsford, UK.
E-mail: katanest@gmail.com

ABSTRACT
Treatment of large soft tissue vascular lesions remains one of the greatest challenges in modern plastic
surgery. The extent of the disease and the involved structures, but also the expectations of the patients
are important in determining the way of treatment. The effective management of hemangiomas
and vascular malformations of the head and neck requires a team approach, in order to understand
the biologic behavior of the lesion, complete the diagnostic studies necessary to define the area of
involvement, and understand the benefits and limitations of interventional radiologic and surgical
procedures. The synthesis of this knowledge can help determine the best treatment. The strategic plan
and subsequent management of a 34-year-old Maori man with an extensive arteriovenous intraparotid
malformation is presented.

Key words:
Embolization, hemangiomas and vascular malformations, intraparotid malformation, vascular lesions

INTRODUCTION CASE REPORT

Treatment of large soft tissue vascular lesions remains A 34-year-old Maori man presented with an extensive
one of the greatest challenges in modern plastic surgery. arteriovenous malformation over his left face. The patient
The extent of the disease and the involved structures, first noted small cherry-sized nodules behind his left
but also the expectations of the patients are important in ear at 8 years of age. His main symptom was recurrent
and spontaneous bleeding, which he controlled with
determining the way of treatment. [1]
direct pressure. The lesion remained quiescent until
The biologic classification of hemangiomas and vascular 10 years later, when he noticed progressive enlargement
malformations (VMs) by Mulliken and Glowacki in the early of the mass. In addition to the frequent bleeding, he
1980s has not only simplified the terminology, but has also began experiencing increasing pain, skin tightness and
clarified their clinical behavior and treatment options. In troublesome pulsation at night [Figures 1-3]. The patient
[2]
most instances, a hemangioma can be differentiated from agreed to publish his facial pictures and signed the form.
a VM by the history. [3] Magnetic resonance imaging (MRI) demonstrated a large
VM, which predominantly filled the superficial aspect of
Access this article online the left parotid gland and extended posteriorly into the
Quick Response Code: left external ear [Figure 4]. Its blood supply was derived
Website:
www.parjournal.net from the left external carotid artery [Figure 5].
In preparation for surgical resection, patient underwent
DOI: embolization 1 week prior to operation. The left occipital
10.4103/2347-9264.135556 artery was embolized with 3 Guglielmi Detachable
Coils (Target Therapeutics, Fremont, California, USA) and

Plast Aesthet Res || Vol 1 || Issue 1 || Jun 2014 33