Paediatric Head and Neck Hemangiomas: Scopes, Challenges and Outcome of Surgical Management

Haemangiomas are benign vascular tumours frequently encountered in head and neck region. The different systems of nomenclature leading to terminological confusion and management protocols for vascular lesions have been contentious issues and have undergone substantial paradigm shift over the years. A wait and watch policy has been the mainstay of treatment owing to spontaneous regression of majority of paediatric hemangiomas along with sclerotherapy, laser therapy, drug therapy and radiotherapy. However, in carefully selected cases, surgical excision; alone or in a combined approach, should be adopted as treatment of choice. Cases of paediatric vascular lesions were diagnosed and appropriately classified as per the recent guidelines of The International Society for the Study of Vascular Anomalies (ISSVA). The cases of haemangiomas were identified and individualized treatment protocols were adopted for every case in a multispecialty team approach. Patients deemed as suitable candidates for surgery were undertaken for excision and the outcome was assessed on the indices of colour, size, aesthetics and patient opinion regarding the outcome. A total of 39 patients with multiple head and neck hemangioma lesions were included, with a female preponderance and mean age of the presentation at 8 years. The most common sites were the buccal mucosa, palate, tongue, and angle of mandible. Among the cases, 12.8% were observed without treatment, 12.8% were treated with sclerotherapy, 51.28% underwent surgery, and 23% received a combined treatment approach with regular follow up. The therapeutic response and patient satisfaction were significantly higher in group with surgical intervention. An individualised, comprehensive and holistic approach towards management of paediatric haemangioma based on appropriate classification system gives optimum treatment outcomes. Proper counselling, reassurance and timely intervention is necessary to preserve cosmetic aesthetics as well as fragile child psychology in this impressionable age group. We feel that surgical approach has been substantially underutilized as preferred treatment modality and may occupy a greater space in paediatric haemangioma treatment in future.