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Vascular Anomalies and Malformations

Definitions

Facial vascular anomalies can be present at birth or acquired after birth. Defined by the visible alteration of the color and appearance of the skin on the face, the lesions form due to the build up of dilated blood vessels. Those formed during embryonic life can be classified based on the type of their blood flow, including slow-flow lesions (capillary, venous, lymphatic), high-flow lesions (arterial) and combined slow/fast-flow lesions.

The most significant acquired infant vascular lesions are hemangiomas, which are benign (non-cancerous) but potentially destructive tumors, composed of proliferating blood vessels. Acquired vascular lesions seen later in life are associated with aging (senile angiomas), trauma (arteriovenous fistulas), systemic conditions (spider angioma), and malignancy (Kaposi sarcoma).

What causes facial vascular anomalies?

Facial vascular anomalies are caused by the dilation and collection of capillaries, which are the small blood vessels close to the surface of the skin. Common types of facial vascular anomalies include:

Port-Wine Stain

A port-wine stain is a red or purple birthmark caused by dilated capillaries in the skin, usually present at birth. It may initially appear pink and may darken and thicken as your child grows. Port-wine stains are found most commonly on the face and neck, but can occur on other parts of the body.

Hemangioma

Hemangiomas are rarely present at birth (congenital hemangioma), but typically appear within the first 2 months of life. They often first appear as a “scratch” or a “pimple” on the surface of the skin, but then continue to grow over the first months of life (“early proliferative phase”). The growth of hemangiomas usually plateaus by 6 months of age, and then continues unchanged until 12 to 18 months of age (“late proliferative phase”). A period of progressive atrophy then begins that takes years to complete (“involutional phase”) and finally remain dormant. Vascular malformations tend to grow proportionally with growth of the child.

Hemangiomas are growths made up of abnormally dense collections of dilated capillaries. Although they have a tumor-like appearance, they are not cancerous. Hemangiomas can be found on any part of the body, including the head and face. The only time to worry about a Hemangioma is if its location affects your child’s vision, breathing or eating.

Arteriovenous malformations

Arteriovenous Malformations (AVM) occurs when there is an abnormal connection between arteries and veins. The size, location and visibility of the malformations can vary, however large malformations may require enough blood flow to put stress on the heart.

Treatment

Treatment for facial vascular anomalies depends on the type of malformation:

Port-Wine Stain

Although no treatment is necessary, if a port-wine stain is found on a child’s face, treatment may be beneficial to promoting a positive self-image. Port-wine stains are treated with laser therapy, which can significantly lighten the appearance of the stain. Early evaluation of facial port-wine stains can help doctors determine if other underlying problems exist. For example, port-wine stains that involve the upper or lower eyelid may also be associated with the development of glaucoma.

Hemangioma

As with port-wine stains, no treatment is necessary for most hemangiomas. However, when a hemangioma is affecting a child’s vision, breathing or eating, or when it is causing a serious deformity of a child’s face, treatment is recommended. Your physician will order an ultrasound or MRI to determine the depth of the hemangioma and the structures involved. Treatment depends on the size and location of the hemangioma, but can include steroids to reduce the size of the malformation, and laser or traditional surgery.

Arteriovenous malformations

Treatment for this type of malformation is surgical removal. Prior to surgery, your physician may recommend embolization, which stops blood flow in the problem vessel, or direct injection of a medicine to promote clotting.

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