[ ]1672-3244(2011)01-0061-07 [ ] 2010-09-26; [ ] 2010-10-25 [ ] Tel:021-23271063Fax:021-63121780 E-mail:zhjw@omschina.org.cn c 2011 [ ] (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. China Journal of Oral and Maxillofacial Surgery Vol.9 No.1 January2011 61 Clinical Guideline (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] 2
62 3 (0~1 ) (1~5 ) (5~10 [7] 3 1 Finn [8] 159 18 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 The protocol of treatment guideline of oral and maxillofacial hemangiomas 1~4 30%
[9] (1) (2) [11] 2 China Journal of Oral and Maxillofacial Surgery Vol.9 No.1 January2011 63 ) ( 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) YAG(1064nm) KTP (1.5~40 ms) 532nm 5~15J/cm 2 [18-21] FPDL KTP 7~14d (panthenol) ; 532nm 4 KTP [1820] [21] CO 2
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 ) 1 1 100~300 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] China Journal of Oral and Maxillofacial Surgery Vol.9 No.1 January2011 65 1.0~1.5 mg/kg 1 1mg/mL 4mg; 3.4.5 1.5~2.0mg/mL
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