| BackgroundVenous malformations (VMs) are the most common vascular malformations. Most of it derives from the phlebectasia caused by congenital developmental disorder of the venous. VM is multiple occurring from head to foot, which is lifelong developing and couldn’t spontaneously involute. The incidence of it was from 1:5000 to 1:10000 approximately, and about 40% of the lesions locate on head and neck. Head and neck VMs often occur in the oral mucosa, tongue, palate, mouth floor, cheek, tempus, parapharyngeal space, and around the parotid gland or trachea. VMs could not only have bad affect on the facial aesthetics, but also lead to pain, blooding, restriction of mouth opening and other functional disorder. The lesion located around the respiratory tract could even cause obstruction of it, which is a threat to life.Foam sclerotherapy is a kind of effective therapeutic method for head and neck VMs. It has been widely used internationally for many years. This method was derived from liquid sclerotherapy, which injected liquid sclerosant into the cyst of the lesion. Through broking the endothelium of the malformed venous and the structure of the vascular wall, it could make the malformed venous blocked to treat the disease finally. However, there were often many complications caused by this method. To reduce these complications, there occurred an alternative method whose character was that foam sclerosant, composed of liquid sclerosant and air, substituted for liquid sclerosant. The head and neck VMs were always large in volume, with the complicated position. If the sclerosant couldn’t enough for making full contact with the endothelial cells of VMs, it would lead to unsatisfactory treatment effect. In other words, if excess foam entered into the normal blood circulation in a short time, it might cause some serious complications, like gas embolism. In order to guarantee the treatment effect with less serious complications, it was essential for establish a novel method for treating head and neck complicated VMs.Ultrasound could describe the location and blood flow of VMs, and the position of the injected foam. It is widely used in the foam sclerotherapy of varicose vein of lower limb. However, the anatomical structure of head and neck is more complicated. In some special position, such as body of tongue, palatine, or covered by maxillary or mandibular bone, the application of ultrasound was limited. For recent years, X-ray and digital subtraction angiography (DSA) has been used for guiding the foam sclerotherapy. DSA could make wider view and clearer image. It isn’t obstructed by bone tissues. Through injecting contrast agent into local lesion, we can constantly observe the position of the lesion and the situation of the veins. Moreover, we can make a rough calculation aboutthe volume of the lesion via the dosage of the contrast agent. Therefore, it is an ideal method for guiding the treatment of the complicated VMs in head and neck. In the tradition DSA, the operators punctured and injected contrast agent to describe the position and volume of the lesion, and then injected same volume foam sclerosant into the cavity. It was two steps of this technique, radiography and treatment, which was complex and needed more time, in addition, the operators and the patients would accept more radiation.ObjectiveTo establish a novel real time development foam sclerotherapy. On one hand, we want to explore the ideal ratio of sclerosant (lauromacrogol), contrast agent (ultravist), and air to make stable radiopaque sclerosing foam. On the other hand, we will apply this foam sclerosant in complicated head and neck VMs, and evaluate the treatment effect and the security of the novel foam sclerosant in complicated head and neck VMs with the guidance of DSA.MethodsRetrospective study of 11 patients with complicated head and neck VMs from 2011 to 2013 in oral and maxillofacial surgery, Qilu hospital of Shandong university. Combine 1% lauromacrogol, Ultravist 300, and air with the volume ratio of 2:1:7 by classical Tessari method to make stable foam. All the patients were treated by this foam sclerosant with the guidance of DSA, and the position and volume of the lesion, operating time, clinical effect and complications were recorded.Results11 patients with complicated head and neck VMs accepted foam sclerotherapy. The position of their lesions were face, parotid area, tempus, neck, tongue, palatine, oral floor, and parapharyngeal space. The average volume of the lesions was 21ml. The average time of treatment was 4, and 10 of the 11 patients was effective, of which,4 patients had entire involution, and 1 patient relapsed. The complications involved swelling after the operation, pain of deglutition, snore and so on, without phlebothrombosis, cutaneous necrosis and other serious complications.ConclusionsThe study established a real time radiopaque foam sclerotherapy with the DSA guidance, and applied this method to treat the complicated head and neck VMs. It is safe and valid in clinical.BackgroundFoam sclerotherapy is an efifective method for treating varicose vein or venous malformations, and lauromacrogol is an extensive used foam sclerosant. The stability of foam is one of the key factors for the therapeutic effect of foam sclerotherapy.It is affected by mutifactors,such as the kind of sclerosant,concentratioon,the ratio of air and liquid,the kind of air,and the temperature. The viscosity is also an important factor that affects the stability of foam sclerosant.References reported that adding glycerinum could enhance the stability of lauromacrogol or sodium tetradecyl sulfate by promoting the viscosity of sclerosant.Hyaluronic acid(HA) is an intrinsic substance of human. In physiological status,there exist some HA in blood. As reported that, it was safe for intravenous injecting HA in the concentration of 0.03-0.75g/L. HA is a natural long chain glucosamine,which is biodegradable, nontoxic and nonimmunogenic. The physical property of it is high viscosity, and hydrosoluble,so it could dissolve in lauromacrogol, but whether it could affect the stability of lauromacrogol foam hasn’t been demonstrated until now.ObjectiveTo evaluate the effect of HA on the stability of lauromacrogol. To provide a basis of using HA to change the stability of lauromacrogol foam.MethodsThree groups were designed according to different volume of HA adding into the1% lauromacrogol. Group A: no 1% HA added into 2ml 1% lauromacrogol with8 ml air. Group B: 0.05 ml 1% HA added into 2ml 1% lauromacrogol with 8ml air.Group C: 0.1 ml 1% HA added into 2ml 1% lauromacrogol with 8ml air. The foam was made by Tessari method, and the foam half time(FHT), which is the time that half volume of the foam reverted into liquid, was adopted to access the foam stabUity. Each group has 5 times time recording.ResultsAll three groups could form stable foam. By comparing the results of the three groups, the low concentration(0.244-0.476g/ L) HA could enhance the stability of 1% lauromacrogol foam significantly. The FHT of group A was 142.8(± 4.32) s.The FHT of group B was 310.6(± 7.53) s. The FHT of group C was 390.4(± 13.06)s.ConclusionsLow concentration HA could improve the stability of lauromacrogol foam. |
PDF Full Text Request