Venous malformations in the face and neck. Radiologic diagnosis and treatment with absolute ethanol

Venous malformations in the face and neck have a characteristic clinical picture. They consist of a cluster of venous cavities with a very slow blood flow and are normally not demonstrated at conventional external carotid angiography. Previous methods of treatment have been of limited value but recently good results have been reported with instillation of fibrosing agents as Ethibloc and ethanol. Five patients with facial venous malformations were referred for therapy. External carotid angiography was performed and was almost normal in all patients. Superselective catheterization demonstrated the malformation clearly in 2 patients only. Direct puncture phlebography confirmed the diagnosis by demonstrating the venous cavities in all the patients. This procedure was concluded by instillation of absolute ethanol into the cavities. There was a marked reduction in size of the malformation but it was not permanently completely occluded. The treatment was repeated in 4 patients with further reduction of the size, but small remnants are still left. Serious complications with extensive soft tissue necrosis occurred in one patient probably as a result of extravasation of ethanol. The necrosis later healed well after surgical treatment. Instillation of ethanol under radiologic control seems to be a promising way of treatment of venous malformations.