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noninvasive imaging such as computed tomography (CT) understanding both the extent and the flow characteristics
or MRI is helpful for assessment of the extent of the of the disease.
disease, associated lesions, or multifocal involvement.
MRI is the most useful single imaging modality in the CONCLUSION
investigation of VMs. The combination of multiplanar
spin echo imaging and flow-sensitive sequences permits Effective management of hemangiomas and VMs of the head
characterization of the nature and extent of most and neck requires a team approach, in order to understand
lesions. Angiography is reserved for patients in whom the biologic behavior of the lesion, complete the diagnostic
a decision has been made to intervene and is generally studies necessary to define the area of involvement, and
performed at the same time as embolization. VM are understand the benefits and limitations of interventional
challenging to treat and require the skills of multiple radiologic and surgical procedures. The synthesis of this
[10]
disciplines. knowledge can help determine the best treatment. [11]
Management of these lesions is best achieved by a
specialist who understands the various clinical expressions REFERENCES
of the problem, the natural history of the lesion, and
the patient’s needs. The primary goal of treatment is to 1. Eivazi B, Werner JA. Venous and arteriovenous malformations in the head
restore and preserve function, stop bleeding, and improve 2. and neck region. Therapeutic options and challenges. HNO 2014;62:19‑24.
Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants
or restore cosmesis. and children: A classification based on endothelial characteristics. Plast Reconstr
Surg 1982;69:412‑22.
Vascular malformation in children under 10 years of 3. Burns AJ, Navarro JA, Cooner RD. Classification of vascular anomalies
age may interfere with natural growth and maturation and the comprehensive treatment of hemangiomas. Plast Reconstr Surg
of the maxillomandibular frame, causing malocclusion of 2009;124:69e‑81.
the mouth or modeling defects owing to external pressure 4. Guglielmi G, Viñuela F, Sepetka I, Macellari V. Electrothrombosis of saccular
on the forming bones or sinuses. Early intervention can aneurysms via endovascular approach. Part 1: Electrochemical basis, technique,
and experimental results. J Neurosurg 1991;75:1‑7.
arrest or even reverse such changes. [6] 5. Guglielmi G, Viñuela F, Dion J, Duckwiler G. Electrothrombosis of saccular
aneurysms via endovascular approach. Part 2: Preliminary clinical experience.
The use of sclerosing and/or embolic agents in the J Neurosurg 1991;75:8‑14.
treatment of hemagiomas was first described by Brooks 6. Niimi Y, Song JK, Berenstein A. Current endovascular management of
in 1931, documented by Edgerton in 1976. Since maxillofacial vascular malformations. Neuroimaging Clin N Am 2007;17:223‑37.
[7]
[8]
then, preoperative embolization of soft tissue vascular 7. Brooks BL. Discussion: Noland and Taylor. Trans South Surg Assoc
lesions became almost the standard of care in the surgical 8. 1931;43:176.
Edgerton MT. The treatment of hemangiomas: With special reference to the
management of these lesions. role of steroid therapy. Ann Surg 1976;183:517‑32.
9. Konas E, Canter HI, Cil B, Peynircioglu B, Karabulut E, Tuncbilek G,
The selection of an appropriate agent depends on Kayikcioglu A, Erk Y. Volumetric assessment of results of treatment of
the type of lesion, the method of embolization, and vascular malformations of the head and neck regions treated with a minimally
the experience of the interventional radiologist. The invasive surgical technique after embolization procedure. J Craniofac Surg
embolization procedure not only decreases the operative 2009;20:402‑5.
bleeding, but also facilitates the identification of a safe 10. Dmytriw AA, Ter Brugge KG, Krings T, Agid R. Endovascular treatment of
head and neck arteriovenous malformations. Neuroradiology 2014;56:227‑36.
tissue plane for surgical excision. 11. Yadav P, De Castro DK, Waner M, Meyer L, Fay A. Vascular anomalies of the
head and neck: A review of genetics. Semin Ophthalmol 2013;28:257‑66.
Total resection is the gold standard. Three-dimensional
(3D) CT scans facilitate both a better understanding of
their complex 3D configuration and their relations with How to cite this article: Anesti K, Moaveni Z, Wu HY. Management
other anatomic structures such as bones and vessels. of extensive intraparotid vascular malformation: a case report. Plast
Aesthet Res 2014;1:33-6.
In addition, postoperative visualization demonstrates
the volume of tissue removed. Conventional imaging Source of Support: Nil, Conflict of Interest: None declared.
[9]
modalities, such as MRI and angiography, are good for Received: 11-03-2014; Accepted: 03-05-2014

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