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• W2118771750 abstract "I read the article “Surgical management of solitary venous malformation in the midcheek region” published in Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics on August 18, 2011,1Zhong L.P. Ow A. Yang W.J. Hu Y.J. Wang L.Z. Zhang C.P. Surgical management of solitary venous malformation in the midcheek region.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; ([Epub ahead of print])PubMed Google Scholar with great interest. I agree that surgical excision is a good treatment option for venous malformations in the head and neck; however, surgical management is not the treatment of choice, especially for the so-called “solitary venous malformation” and for young patients who care much for their appearance.Venous malformation is not a benign tumor, but a congenital vascular malformation without clear demarcation from surrounding tissues. Although complete removal should be attempted whenever possible, when dealing with a diffuse venous malformation, this is often impossible without compromising the function and appearance of the patient, because intraoperative bleeding often makes identification and preservation of important structures difficult during surgical excision.2Buckmiller L.M. Richter G.T. Suen J.Y. Diagnosis and management of hemangiomas and vascular malformations of the head and neck.Oral Dis. 2010; 16: 405-418Crossref PubMed Scopus (179) Google Scholar Therefore, therapy is used to control expansion, maintain cosmesis, and decrease symptoms, rather than complete resection.With the advent of new sclerosing agents and improvement in techniques, sclerotherapy has been suggested as the first-line treatment of low-flow vascular malformations instead of surgical intervention.3Uehara S. Osuga K. Yoneda A. Oue T. Yamanaka H. Fukuzawa M. Intralesional sclerotherapy for subcutaneous venous malformations in children.Pediatr Surg Int. 2009; 25: 709-713Crossref PubMed Scopus (30) Google Scholar, 4Blaise S. Charavin-Cocuzza M. Riom H. Brix M. Seinturier C. Diamand J.M. et al.Treatment of low-flow vascular malformations by ultrasound-guided sclerotherapy with polidocanol foam: 24 cases and literature review.Eur J Vasc Endovasc Surg. 2011; 41: 412-417Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar It can be used as a definite treatment modality for small to medium-sized (<5 cm in diameter) lesions, including solitary lesions, with excellent results, or used as a supplement to surgery for larger or extensive lesions. In our recent experience, solitary venous malformation in the head and neck region can be cured with intralesional injection of bleomycin A5 (pingyangmycin) without any surgery-associated complications, such as scarring, infection, local depression, facial nerve injury, and so forth. Surgery is used only for the failure of sclerotherapy in these cases, instead of primary treatment of these lesions.Another deliberation is related to the preoperative investigation. Magnetic resonance imaging (MRI) remains the diagnostic modality of choice to assess extent and to plan treatment for venous malformations.2Buckmiller L.M. Richter G.T. Suen J.Y. Diagnosis and management of hemangiomas and vascular malformations of the head and neck.Oral Dis. 2010; 16: 405-418Crossref PubMed Scopus (179) Google Scholar Doppler ultrasonography may aid in clinical diagnosis, but computed tomography scanning provides little valuable information for soft tissue lesions, including venous malformations, and should be used very cautiously owing to its poor soft tissue contrast and high radiation risk. Fine-needle aspiration cytology is a diagnostic procedure used to investigate superficial and deeper masses, from which cells are extracted with a thin, hollow needle and then examined under a microscope after being stained. Venous malformation possesses distinct clinical presentations and MRI features, and diagnosis is usually made based on clinical examinations and imaging findings. Fine needle aspirations always yield venous blood or blood-tinged fluid without any cellular components; therefore, fine-needle aspiration cytology is unnecessary and improper for preoperative diagnosis of venous malformations. I read the article “Surgical management of solitary venous malformation in the midcheek region” published in Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics on August 18, 2011,1Zhong L.P. Ow A. Yang W.J. Hu Y.J. Wang L.Z. Zhang C.P. Surgical management of solitary venous malformation in the midcheek region.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; ([Epub ahead of print])PubMed Google Scholar with great interest. I agree that surgical excision is a good treatment option for venous malformations in the head and neck; however, surgical management is not the treatment of choice, especially for the so-called “solitary venous malformation” and for young patients who care much for their appearance. Venous malformation is not a benign tumor, but a congenital vascular malformation without clear demarcation from surrounding tissues. Although complete removal should be attempted whenever possible, when dealing with a diffuse venous malformation, this is often impossible without compromising the function and appearance of the patient, because intraoperative bleeding often makes identification and preservation of important structures difficult during surgical excision.2Buckmiller L.M. Richter G.T. Suen J.Y. Diagnosis and management of hemangiomas and vascular malformations of the head and neck.Oral Dis. 2010; 16: 405-418Crossref PubMed Scopus (179) Google Scholar Therefore, therapy is used to control expansion, maintain cosmesis, and decrease symptoms, rather than complete resection. With the advent of new sclerosing agents and improvement in techniques, sclerotherapy has been suggested as the first-line treatment of low-flow vascular malformations instead of surgical intervention.3Uehara S. Osuga K. Yoneda A. Oue T. Yamanaka H. Fukuzawa M. Intralesional sclerotherapy for subcutaneous venous malformations in children.Pediatr Surg Int. 2009; 25: 709-713Crossref PubMed Scopus (30) Google Scholar, 4Blaise S. Charavin-Cocuzza M. Riom H. Brix M. Seinturier C. Diamand J.M. et al.Treatment of low-flow vascular malformations by ultrasound-guided sclerotherapy with polidocanol foam: 24 cases and literature review.Eur J Vasc Endovasc Surg. 2011; 41: 412-417Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar It can be used as a definite treatment modality for small to medium-sized (<5 cm in diameter) lesions, including solitary lesions, with excellent results, or used as a supplement to surgery for larger or extensive lesions. In our recent experience, solitary venous malformation in the head and neck region can be cured with intralesional injection of bleomycin A5 (pingyangmycin) without any surgery-associated complications, such as scarring, infection, local depression, facial nerve injury, and so forth. Surgery is used only for the failure of sclerotherapy in these cases, instead of primary treatment of these lesions. Another deliberation is related to the preoperative investigation. Magnetic resonance imaging (MRI) remains the diagnostic modality of choice to assess extent and to plan treatment for venous malformations.2Buckmiller L.M. Richter G.T. Suen J.Y. Diagnosis and management of hemangiomas and vascular malformations of the head and neck.Oral Dis. 2010; 16: 405-418Crossref PubMed Scopus (179) Google Scholar Doppler ultrasonography may aid in clinical diagnosis, but computed tomography scanning provides little valuable information for soft tissue lesions, including venous malformations, and should be used very cautiously owing to its poor soft tissue contrast and high radiation risk. Fine-needle aspiration cytology is a diagnostic procedure used to investigate superficial and deeper masses, from which cells are extracted with a thin, hollow needle and then examined under a microscope after being stained. Venous malformation possesses distinct clinical presentations and MRI features, and diagnosis is usually made based on clinical examinations and imaging findings. Fine needle aspirations always yield venous blood or blood-tinged fluid without any cellular components; therefore, fine-needle aspiration cytology is unnecessary and improper for preoperative diagnosis of venous malformations. Surgical management of solitary venous malformation in the midcheek regionOral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyVol. 114Issue 2PreviewThe aim of this study was to analyze a single institution's experience of solitary venous malformation (VM) in the midcheek region. Full-Text PDF Comment on surgical management of solitary venous malformation in the midcheek region: replyOral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyVol. 113Issue 3PreviewGenerally, for most venous malformations, especially diffuse venous malformations, surgery is not the only choice of treatment, and we agree that sclerotherapy could be used as the first choice under most conditions, and surgery sometimes could be used to improve the result. For the solitary venous malformation in the midcheek region, however, based on our prognostic result, we suggest surgery as the choice of treatment. Full-Text PDF" @default.
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