Paediatric vascular malformations of head and neck: From diagnosis to treatment

OBJECTIVES Vascular anomalies frequently involve the face are a pathological entity, consisting of different types of tumors and malformations that can affect the head and neck in paediatric patients and these may have a very variable clinical presentation. To reach a correct diagnosis and treatment it is actually necessary to have a thorough knowledge of these disorders. Classification and treatment options have significantly changed over the years, from Mulliken and Glowacki in 1982 to the international guidelines of the ISSVA in 2018 (International Society for the Study of Vascular Anomalies). The purpose of this review is that of deepening the knowledge of the vascular anomalies concerning the head and neck district in paediatric age, providing the indispensable knowledge for the correct diagnosis and for the subsequent corrects therapeutic procedure. MATERIALS AND METHODS This is a non-systematic review of the literature using as research terms: “vascular anomalies”, “vascular malformations”, “venous arterial malformations (VM)", “capillary malformations”, “lymphatic malformations”, “primary lymphedema”, “primary lymphatic dysplasia” or “combination” of the head and neck in paediatric patients. The articles that were not written in english have been excluded. The most recent studies, that best described etiopathogenesis, clinical- radiological characteristics and therapeutic course of patients suffering from vascular malformations of the craniofacial district in childhood, were included. RESULTS Vascular anomalies represent a rather frequent clinical entity in the general population, although still remain understood. Their clinical course is poorly predictable, because they can remain asymptomatic as whereas they can worsen with acute or subclinical onset. Intraosseous vascular malformations can often occur in the mandible. They represent a pathological entity which can be dangerous in paediatric patients: they can have a presentation with an acute important uncontrolled bleeding, especially during ambulatorial surgical procedures such as the extraction of deciduous or permanent teeth. Treatment can often combine different kind of interventional procedure (embolization or sclerotization procedures) with or without surgical procedures. CONCLUSIONS The correct classification, diagnosis and treatment indications of vascular anomalies is really important, in consideration of the morbidity and complications that may occur (uncontrollable and severe bleeding). The paediatric dentist, who is often the first figure to visit these patients, plays a fundamental role for the diagnosis. The correct diagnosis and therapeutic choice of vascular anomalies is mandatory, in consideration of the important complications that can be associated with them (even severe bleeding, often uncontrollable). The purpose of this review is to underline the need for a multidisciplinary approach involving dentists, paediatricians, surgeons and interventional radiologists, which leads to a correct diagnostic classification and allows its correct treatment. Different therapeutic approaches can be applied in combination or individually to achieve the patient’s quality of life as the sole purpose. Often the indication for treatment is the result of a compromise between surgical radicality and possible complications. The paediatric dentist, who is often the first figure to whom these patients turn, must play a fundamental role in timely diagnosis. CLINICAL SIGNIFICANCE The diagnosis in the paediatric population is mandatory to reduce the risk related to spontaneous bleeding due also to small surgical procedures.