Treatment of Infantile Hemangiomas of the Head and Neck

Fig. 16.1

A child with a compound (superficial and deep components) left glabellar/paranasal IH. During surgery an elliptical incision was used to remove the IH. A local rotation flap was used, and the standing cone was corrected 3 weeks later. The patient has undergone scar revisions and multiple laser treatments. These procedures were done prior to the discovery of propranolol. Since we do see partial or nonresponders to propranolol, the technique of treatment described above is still relevant

Fig. 16.2

A child with a midline forehead hemangioma. This was a pedunculated lesion, and after much discussion, the parents elected to proceed with surgery. The lesion was resected through a vertical midline ellipse. Since this was a pedunculated lesion, there was sufficient skin left to prevent significant medial movement of the brows

Fig. 16.3

This child is a twin who presented with a hemangioma that involved her left nostril, upper lip, and nasolabial area. The area around the nostril was resected initially. This was followed with laser treatment and a perialar flap which was used to reconstruct her nasal sill. The standing cone that resulted from this was corrected 3 weeks later. This is a difficult area to correct and should be approached in a staged manner

Fig. 16.4

An infant with a nasal tip hemangioma. This was treated with propranolol and pulsed dye laser until 10 months of age. The patient then underwent surgical resection to correct the Cyrano nasal deformity. In these cases, the hemangioma originates in the midline, between the lower lateral nasal cartilages. As it proliferates, it displaces the cartilages laterally and rotates them outward. A modified subunit approach allows resection of redundant skin and approximation of the lower lateral cartilages. Even if the hemangioma was left untreated and allowed to involute spontaneously, the distortion of the lower lateral cartilages will leave a permanent nasal tip deformity