Modern Management of Nasal Hemangiomas.

Document Type

Article

Abstract

IMPORTANCE: Current treatment approaches for infantile hemangiomas of the nose include observation, pharmacologic agents, surgery, and/or laser therapy. Because of the known functional, social, and cosmetic effect of nasal deformities, obtaining the best possible result is critical. Optimal timing, type, duration, and extent of therapy remain unclear.

OBSERVATIONS: Results of a review of 86 patients (64 females and 22 males; mean age, 4.8 months [range, 2 days-23 years]) with infantile hemangiomas of the nose treated from January 1, 1999, to December 31, 2015, and a review of the literature are presented to gain insight into the preferred approach to the treatment of these lesions. Patients underwent single-modality and multimodality treatment with pulsed-dye laser (n = 73), oral corticosteroids (n = 11), intralesional corticosteroids (n = 2), propranolol hydrochloride (n = 30), and surgery (n = 50). The treatment decision algorithms and outcomes based on tumor phase and infantile hemangioma subtype are reviewed in detail. Nine articles met the criteria to be included in the literature review. Literature from the era before the approval of propranolol advocates for early use of oral or intralesional corticosteroids followed by surgery or pulsed-dye laser in cases of unacceptable outcomes. Literature from the era after the approval of propranolol supports early initiation of oral β-blockers until proliferation ceases or until additional intervention is necessary.

CONCLUSIONS AND RELEVANCE: Despite a lack of higher levels of evidence, there exists a general consensus between the literature and clinical experience advocating for early multimodality treatment to achieve the best result possible by the time the children reach certain sociodevelopmental milestones.

Medical Subject Headings

Adolescent; Adrenal Cortex Hormones; Adult; Algorithms; Child; Child, Preschool; Combined Modality Therapy; Early Medical Intervention; Hemangioma; Humans; Infant; Infant, Newborn; Injections, Intralesional; Lasers, Dye; Nose Neoplasms; Outcome and Process Assessment, Health Care; Propranolol; Rhinoplasty; Young Adult

Publication Date

7-1-2017

Publication Title

JAMA Facial Plast Surg

ISSN

2168-6092

Volume

19

Issue

4

First Page

327

Last Page

332

PubMed ID

28494055

Digital Object Identifier (DOI)

10.1001/jamafacial.2017.0197

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