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Feasible Removal of Facial Hemangiomas Under Local Anesthesia in Young Children
Nissim Hazkour1, Jose Palacios2, Sammy Othman3
1SUNY Downstate College of Medicine, Brooklyn.
Insights
Facial hemangioma excision in children under 4 using local anesthesia alone is safe and effective. This method reduces parental anxiety and offers high satisfaction, proving a viable alternative to general anesthesia.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Anesthesiology
Background:
- Facial hemangiomas in young children are typically treated surgically under general anesthesia.
- Surgeons often avoid local anesthesia due to concerns about patient/parental anxiety and blood loss.
Purpose of the Study:
- To evaluate the safety and efficacy of excising facial hemangiomas under local anesthesia alone in children under 4.
- To assess parental satisfaction and anxiety levels following the procedure.
Main Methods:
- A retrospective review of 18 children undergoing in-office facial hemangioma excision by a single plastic surgeon.
- Minimum 3-month follow-up, recording complications and recurrence.
- Post-treatment parental surveys on satisfaction and anxiety.
Main Results:
- 18 children (mean age 12 months) underwent successful in-office excision.
- 56% complete resolution at 12 months; no significant complications reported.
- Parental anxiety decreased significantly post-procedure, with high satisfaction ratings.
Conclusions:
- Facial hemangioma removal under local anesthesia alone is a safe and feasible option for pediatric patients.
- This approach can reduce patient and parental anxiety compared to general anesthesia.
Background:
Facial Hemangiomas are often recommended to be removed exclusively in the operating room under general anesthesia, especially for children under the age of 4. Assumed parental and patient anxiety and possible blood loss pushes surgeons away from attempting excision under local anesthesia.
Methods:
A review was conducted to assess the outcomes of children who underwent excision of facial hemangiomas under local anesthesia alone by 1 plastic surgeon with a minimum of 3 months follow-up. Complications and hemangioma recurrence were recorded. A survey was given 3 to 6 months after treatment to assess parental satisfaction, anxiety, and thought process about anesthesia.
Results:
Eighteen children (9 males and 9 females) underwent in-office excision between 2020 and 2021. The mean age of this cohort was 12 months ( ranging 2-52 m). The average facial hemangioma size was 2.088 cm (ranging 1.0-3.2 cm). Ten patients experienced complete resolution (56%) at 12-month follow-up. There were no hospitalizations or cases of significant (>10 mL) blood loss, infection, dehiscence, hematoma, or scar hypertrophy. The average level of parental anxiety before the procedure was 3.3/10, and 1.6/10 after the procedure. Total 13/14 parents gave 4/4 ratings for satisfaction with the quality of care, team responsiveness, pain management, and management of expectations.
Conclusions:
Facial hemangioma removal under local anesthesia alone is a safe and feasible alternative treatment method for patients younger than 4 years of age.
