Vascular Malformations of Head and Neck Region: Our Experience at Mayo Hospital, Lahore.

Abstract

Background: Vascular malformations of head and neck region are present in approximately 0.3% to 0.5% population and usually noticed in early childhood. They keep on growing in proportion to growth of the child with no regression. For management point of view, vascular malformations are categorized into low flow (Lymphatic, Capillary and Venus) and high flow. Diagnosis of vascular malformation is established by clinical examination easily but sometimes, regardless of clinical signs, radiological adjuncts (Doppler, MRI) are mandatory. Treatment option depends upon size and type of malformation (low or high flow). Objective: To study different types of vascular malformations in head and neck region and their response to various treatments in our population. Methodology: This prospective study was conducted in Plastic Surgery Department, Mayo Hospital, Lahore, Pakistan, from Feb 2017 to Jan 2018. Doppler was done in all patients; MRI was done where necessary to find out extent of the malformation while CT angiography in few cases to map out feeding vessels. Treatment was based on type, size and location of the malformation. Compression, sclerotherapy, LASER and surgical de-bulking alone or in combination were among the treatments. Results: A total of 140 patients were included out of which 79(56%) were males and 61(44%) were females. Mean age was 22(±16) years (range 6-50 years). Low flow malformations were 98(70%) out of which 27(19%) were capillary, 31(22%) venous and 40(28%) were combined. High flow malformations were in 42(30%) where 9(6%) were arterial and 33(25%) arteriovenous. Operative treatment and adjuncts, alone or in combination, were employed depending on type of malformation. Satisfaction with outcome was more in patients having combination therapy. Non-surgical modalities, when used alone, were not sufficient to produce desired results Conclusion: Surgical debulking, with or without non surgical technique, proved to be the mainstay to have good outcome.