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Endoscopic transmucosal direct puncture sclerotherapy for management of airway vascular malformations
Author(s) -
Oomen Karin P. Q.,
Paramasivam Srinivasan,
Waner Milton,
Niimi Yasunari,
Fifi Johanna T.,
Berenstein Alejandro,
O Teresa M.
Publication year - 2016
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25284
Subject(s) - medicine , sclerotherapy , laryngoscopy , venous malformation , surgery , airway , larynx , epiglottis , radiology , intubation
Objectives/Hypothesis To describe a multidisciplinary approach to the treatment of airway vascular malformations (venous or lymphatic) with direct suspension rigid laryngoscopy and direct puncture transmucosal bleomycin sclerotherapy injected under road‐mapping fluoroscopic monitoring, supplemented by Dyna‐computed tomography utilization. Study Design Case series. Methods We performed a retrospective medical record and imaging review of four patients with venous malformations or lymphatic malformations located in the airway. Patients were treated with a combination of direct suspension laryngoscopy or rigid nasopharyngoscopy and image‐guided direct puncture bleomycin sclerotherapy. Results Two patients presented to our institution with extensive lymphatic malformation of the neck, parapharyngeal, and retropharyngeal spaces, and two presented with venous malformation of the nasopharynx and oropharynx. All patients were treated with multiple sclerotherapy and debulking procedures before undergoing combined direct transmucosal puncture bleomycin sclerotherapy guided by direct laryngoscopy or nasopharyngoscopy. All patients had complete resolution of disease while maintaining a safe airway. Conclusions A multidisciplinary approach to airway vascular malformations with a combination of endoscopy and direct puncture bleomycin sclerotherapy was demonstrated to be a safe and effective treatment in our patient cohort. Direct laryngoscopy and nasopharyngoscopy provide easy access to the nasopharynx, oropharynx, retro‐ and/or parapharyngeal spaces and larynx. Unlike traditional agents, bleomycin induces minimal edema and therefore is an ideal substance to treat airway lesions. Level of Evidence 4. Laryngoscope , 126:205–211, 2016