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J Plast Reconstr Aesthet Surg. 2016 Mar;69(3):295-304. doi: 10.1016/j.bjps.2015.10.045. Epub 2015 Nov 18.

Sclerotherapy for low-flow vascular malformations of the head and neck: A systematic review of sclerosing agents.

Author information

1
Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: s.e.horbach@amc.uva.nl.
2
Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands; Department of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands.
3
Department of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands.
4
Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.
5
Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands.

Abstract

BACKGROUND:

Sclerotherapy has become the gold standard for the first-line therapy of most venous (VMs) and lymphatic malformations (LMs) of the head and neck. Numerous sclerosing agents are used to treat these low-flow vascular malformations; however, to date, it remains unclear which sclerosing agent is superior in terms of effectiveness and safety.

METHODS:

In a systematic review of the literature (1995-present), we compare the effectiveness and complications of the sclerosing agents most commonly used for cervicocraniofacial VMs and LMs.

RESULTS:

The literature search yielded 1155 articles, among which 36 (1552 patients) were included in the systematic review. The quality of evidence was low. Pingyangmycin, absolute ethanol, OK-432, ethanolamine oleate, bleomycin, polidocanol, doxycycline, and sodium tetradecyl sulfate (STS) were the most reported sclerosing agents. All agents seem effective, and the mean overall response varies from 71% to 100%. Complications occurred more frequently after ethanol sclerotherapy (18%), compared to other sclerosing agents (0-6%). Cellulitis and ulceration were encountered following sclerotherapy with most sclerosing agents, but skin necrosis was particularly observed after ethanol. Facial nerve paralysis occurred only after OK-432 (0.05%) and ethanol sclerotherapy (6%).

CONCLUSIONS:

This systematic review could not identify a significantly superior sclerosing agent in terms of effectiveness, due to the low quality of the available evidence. Until stronger evidence is available, the difference in complication rates is potentially the deciding factor in the choice between sclerosing agents. As a significantly higher complication rate and more severe local complications were encountered after using absolute ethanol, we cannot recommend this agent for sclerotherapy of cervicofacial vascular malformations.

KEYWORDS:

Craniofacial; Head and neck; Lymphatic malformations; Sclerotherapy; Vascular malformations; Venous malformations

PMID:
26723834
DOI:
10.1016/j.bjps.2015.10.045
[Indexed for MEDLINE]

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