China Journal of Oral and Maxillofacial Surgery Vol.9 No.1 January2011 61 [ ]1672-3244(2011)01-0061-07 Clinical Guideline [ ] (hemangioma) 40%~60% [ ] ; ; [ ] R739.8 [ ] A The protocol of treatment guideline of oral and maxillofacial hemangiomas (Division of Vascular Anomalies Chinese Society of Oral and Maxillofacial Surgery Chinese Stomatological AssociationChina) [Summary] Hemangiomas are the most common benign vascular tumors of infancy and childhoodand 40%-60% occur in the head and neck region. As hemangioma could regress spontaneously it generally do not require treatment unless proliferation interferes with normal function or gives rise to risk of serious disfigurement and complications unlikely to resolve without treatment. Various methods to infantile hemangiomas have been describedincluding wait and see policy laser therapydrug therapy (corticosteroidimiquimodpropranolol)sclerotherapy (corticosteroidpingyangmycin) radiotherapysurgery and so on but none of these therapies can be used for all hemangiomas. The type of treatment advised for hemangioma mainly depends on the location depth size current phase and functional impairment of lesions. The treatment protocol should be individualized and comprehensive as well as sequential in order to obtain the best treatment outcome for an individual. Based on the published literatures and clinical experiences we establish a treatment guideline to provide a criterion for the management of oral and maxillofacial hemangiomas. This protocol will be renewed and updated to include and reflect the cutting edge knowledge and provide newest treatment modalities to benefit our patients. [Key words] Oral and maxillofacial region; Hemangioma; Guideline China J Oral Maxillofac Surg20119(1):61-67. (hemangioma) 2%~3%1 2 10% Mulliken [5] 22%~30% [1] 1982 60% (25%) Waner Suen [6] (1995) (15%) 1 3~1 4 [2-4] [ ] 2010-09-26; [ ] 2010-10-25 [ ] Tel:021-23271063Fax:021-63121780 E-mail:zhjw@omschina.org.cn c 2011 2
62 The protocol of treatment guideline of oral and maxillofacial hemangiomas 3 (0~1 ) (1~5 ) (5~10 [7] 3 1 Finn [8] 159 6 1 81% 1~2 2 4~ 6 ; 40%~50% 2~3 5~10 2008 5 50%~60%7 75%9 [9] 90% 10%~20% Head Neck [10] 1 18 1~4 30%
China Journal of Oral and Maxillofacial Surgery Vol.9 No.1 January2011 63 [9] (1) (2) [11] 2 ) ( α ) + ( ) (3) (4) ( ) ; 3.1 T1 T2 ; [12-15] T1 :1 ;2 ;3 ( ) ;4 ( Kasabach-Mer- );5 ;6 ritt 3.2 ( α-2a 2b ) 90 Sr ( Nd:YAG 90 20 60 3 [16]
64 The protocol of treatment guideline of oral and maxillofacial hemangiomas [17] [22-23] (-32 ) 3.3.3 Nd:YAG (neodymium:yttrium alumium gar- 3.3 net) Nd:YAG (1064nm) Nd:YAG 4~6mm [18] Nd:YAG Nd:YAG ( ) [19] ( 2~4 ) Nd:YAG 3.3.1 (488 ~ Nd:YAG 514nm) 40% 1~4d [19] 5d 3.3.2 (flashlamp-pumped pulsed dye laser FPDL) FPDL 2~4 2 5~8 [19] FPDL Nd:YAG 2cm [24] FPDL 585 ~595nm 300 ~ 450μs 2~10mm 3~10J/cm 2 [25-26] ( ) KTP(potassium titanyl phosphate) ( ) Nd: PDL (585 590 595 600 nm) [18-21] (1.5~40 ms) 532nm 5~15J/cm 2 FPDL KTP 7~14d (panthenol) ; 532nm 4 KTP [1820] [21] YAG(1064nm) KTP CO 2
China Journal of Oral and Maxillofacial Surgery Vol.9 No.1 January2011 65 8mg 1.5cm ; 3~5 [19] [30-31] 7~30 3.4 3.4.3 α(ifn-α) IFN-α 1 300 U/m 2 3 α ( 80%~90% [2132-33] IFN-α ) 3.4.1 1967 IU/m 2 ; 1 8 [34] Zarem IFN-α IFN-α (Little ) 4mg/kg 1 1 1 3 ; 3.4.4 β 5mg/kg1 3 4~8 Léauté-Labrèze [35] 3~5mg/kg 8 ; 9 1/2; 10 10mg; 11 5mg; 12 1 4~6 1~10 [27] [28] 2d ( ) ( ) 3.4.2 94.5% >2 mg/ (kg d) [28-29] 1 1 100~300 1.0~1.5 mg/kg 1 1mg/mL 4mg; 3.4.5 1.5~2.0mg/mL
66 The protocol of treatment guideline of oral and maxillofacial hemangiomas ;2 2002 Martinez [28] ;3 ;4 α(ifn-α) -6(IL-6) [36] -α(tnf-α) [37] IL-12 5% : 1 ; 2 1 3~5 ;3 [38-39] [42] PDGF) ;4 ;5 3.4.6 : [40-41] [ ] ( [1] Jacobs AH Walton RG.The incidence of birthmarks in the neonate [J]. Pediatrics 1976 58(2):218-222. 3.5 [2] Pratt AG.Birthmarks in infants [J].AMA Arch Derm Syphilol X γ 195367(3):302-305. [3] Amir J Metzker A Krikler R et a1. Strawberry hemangioma in preterm infants[j].pediatr Dermatol19863(4):331-332. [4] Holmdahl K. Cutaneous hemangiomas in premature and mature infants[j].acta Paediatr19554(4):370-379. [5] Mulliken JB Glowacki J. Hemangioma and vascularmalformations Kasabach-Merritt in infants and children: a classification based on endothelial 2Gy 10Gy [43] characteristics [J]. Plast Reconstr Surg 1982 69(3):412-420. [6] Waner M Suen JY. Hemangiomas and vascular malformations of 90 ( 90 Sr) the head and neck [M]. New York: Wiley-Liss Inc. 1999:357- [44] 5893-169. [7] Tan ST Velickovic M Ruger BM et al. Cellular and extracellu- lar markers of hemangioma[j]. Plast Reconstr Surg2000106(3): [45] 529-538. [8] Finn MC Glowacki J Mulliken JB. Congenital vascular lesions: clinical application of a new classification[j]. J Pediatr Surg1983 18(6):894-900. 3.6 200888 (44):3102-3107. [10] Zheng JW Zhou Q Yang XJ et al. Treatment guideline for hemangiomas and vascular malformations of the head and neck[j]. Head Neck 201032(8):1088-98. [11] :1 2003 19(2):138-141. [9]. [J].. [J].
China Journal of Oral and Maxillofacial Surgery Vol.9 No.1 January2011 67 giomas of early childhood with a new method of cryosurgery [J]. J Am Acad Dermatol200042(5 Pt 1):809-813. [18] Tanzi EL Lupton JR Alster TS. Lasers in dermatology: four decades of progress[j]. J Am Acad Dermatol 200349:1-31. [19] Al Buainian H Verhaeghe E Dierckxsens L et al. Early treatment of hemangiomas with lasers. A review [J]. Dermatol 2003206(4):370-373. [20] Stier MF Glick SA Hirsch RJ. Laser treatment of pediatric vascular lesions: Port wine stains and hemangiomas [J]. J Am Acad Dermatol200858(2):261-285. fect of interleukin 12 during early growth of human pancreatic cancer in SCID mice[j]. Pancreas200020:227-233. [21]. [J]. [38] Barry RB Hughes BR Cook LJ. Involution of infantile haeman- 200716(4):337-342. [22] Witman PM Wagner AM Scherer K et al. Complications following pulsed dye laser treatment of superficial hemangiomas [J]. Lasers Surg Med 200638(2):116-123. [23] Levine VJ Geronemus RG. Adverse effects associated with the577- and 585-nanometer pulsed dye laser in the treatment of cutaneous vascular lesions: a study of 500 patients[j]. J Am Acad Dermatol199532:613-617. [24] Ulrich H B 覿 umler W Hohenleutner U Landthaler M. Neodymium-YAG Laser for hemangiomas and vascular malformations -- long term results[j]. J Dtsch Dermatol Ges20053(6):436-440. [25] Cholewa D Waldschmidt J. Laser treatment of hemangiomas of the larynx and trachea[j]. Lasers Surg Med199823(4):221-232. [26] Kato M Chiba Y Sakai K et al. Endoscopic neodymium:yttrium aluminium garnet (Nd:YAG) laser irradiation of a bladder hemangioma associated with Klippel-Weber syndrome[j]. Int J Urol 20007(4):145-148. 834-839. [27] Frieden IJ Haggstrom AN Drolet BA et al. Infantile hemangiomas: current knowledge future directions. Proceedings of a research workshop on infantile hemangiomas April 7-9 2005 Bethesda Maryland USA [J]. Pediatr Dermatol20052 (5):383-406. [44] [45] 90. [J]. 200525(10):52-53. Lindberg S. Radiotherapy of childhood haemangiomas: from active treatment to radiation risk estimates [J]. Radiat Environ Biophys 2001 40(3):179-189. [28]. ( [J]. 20064(3):228-332. [30]. [31]. [J]. 2003 [12] van Rijswijk CS van der Linden E van der Woude HJ et al. Value of dynamic contrast- enhanced MR imaging in diagnosing [29] Chantharatanapiboon W. Intralesional corticosteroid therapy in hemangiomas: clinical outcome in 160 cases [J]. J Med Assoc and classifying peripheral vascular malformations [J]. Am J Thai20081(Suppl 3):S90-96. Roentgenol2002178:1181-1187. [13] Baker LL Dillon WP Hieshima GB et al. Hemangiomas and vascular malformations of the head and neck:mr characterization [J]. Am J Neuroradiol199415(1):193-195. [J]. 200110(4):295-298. [14] Chooi WK Woodhouse N Coley SC et al. Pediatric head and 1(2):102-105. neck lesions: Assessment of vascularity by MR digital subtraction angiography[j].am J Neuroradiol200425:1251-1255. [32] Greinwald JH Jr Burke DK Bonthius DJ et al. An update on the treatment of hemangiomas in children with interferon alfa-2a[j]. [15].MRI Arch Otolaryngol Head Neck Surg1999125(1):21-27. [J]. 200018(6):404-407. [33] Bauman NM Burke DK Smith RJ. Treatment of massive or lifethreatening hemangiomas with recombinant alpha (2a)-interferon [16] Drake LA Ceilley RI Cornelison RL et al. Guidelines of care [J]. Otolaryngol Head Neck Surg 199717(1):99-110. for cryosurgery[j]. J Am Acad Dermatol199431:648-653. [34] Kaselas C Tsikopoulos G Papouis Get al. Intralesional administration [17] Reischle S Schuller -Petrovic S. Treatment of capillary heman- of interferon A for the management of severe haemangiomas[j].pediatr Surg Int200723(3):215-218. [35] Léauté-Labrèze C Dumas de la Roque E Hubiche T et al. Propranolol for severe hemangiomas of infancy [J]. N Engl J Med 2008358(24):2649-2651. [36] Martinez MI Sanchez-Carpintero I North PE et al. Infantile hemangioma: clinical resolution with 5% imiquimod cream [J]. Arch Dermatol 2002138(7):881-884. [37] Sunamura M Sun L Lozonschi L et al. The antiangiogenesis ef- giomas after imiquimod 5% cream[j]. Clin Exp Dermatol 200833 (4):446-449. [39] Ho NT Lansang P Pope E. Topical imiquimod in the treatment of infantile hemangiomas: a retrospective study [J]. J Am Acad Dermatol 200756(1):63-68. [40] Pandey A Gangopadhyay AN Upadhyay VD. Evaluation and management of infantile hemangioma: an overview [J]. Ostomy Wound Manage 200854(5):16-29. [41] Fawcett SL Grant I Hall PN et al. Vincristine as a treatment for a large haemangioma threatening vital functions [J]. Br J Plast Surg 200457(2):168-171. [42] Sugarman JL Mauro TM Frieden IJ. Treatment of an ulcerated hemangioma with recombinant platelet -derived growth factor [J]. Arch Dermatol 2002138(3):314-316. [43] Ogino I Torikai K Kobayasi S et al. Radiation therapy for lifeor function-threatening infant hemangioma[j]. Radiol 2001218 (3): )