Surgical management of head and neck vascular malformations

Abstract

Head and neck vascular malformations (HNVM) arise from different types of vessels. All can adversely affect function, depending on their size and location. A primary concern is preserving or restoring normal breathing, vision, speech, and eating. After the impact of the HNVM on function has been determined, an accurate diagnosis of the lesion must be obtained with history, exam, and imaging studies; occasionally, a biopsy is necessary to solidify the diagnosis. Once the diagnosis is established, a variety of intradisciplinary treatment modalities are necessary for HNVM management, as often HNVM can be recalcitrant to cure. Paramount in any treatment is the need to preserve function and not induce further morbidity (i.e., motor nerve injury, scarring, stenosis, etc.). In general, localized HNVM can be treated successfully, whereas more extensive lesions need long-term management. Long-term HNVM management needs to be focused on chronic problems that can be associated with these lesions. These malformations can have intermittent swelling that is painful or induces functional compromise. Medical therapy directed at reduction of swelling and pain is essential. When functional compromise is present, therapeutic intervention may be required. Occasionally, these lesions become infected or reduce normal infection barriers predisposing patients to infection (i.e., meningitis from skull base erosion): judicious use of antibiotics is necessary in these circumstances. Chronic problems induced by HNVM morbidity and possibly by treatment complications can have significant adverse psychosocial impact on patients: this must be addressed when caring for affected individuals.