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Complicated Infantile Hemangioma of the Lip: Outcomes of Early versus Late Resection

Hynes, Sally M.D.; Narasimhan, Kailash M.D.; Courtemanche, Douglas J. M.D., M.S.; Arneja, Jugpal S. M.D., M.B.A.

Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e31827c6fe2
Pediatric/Craniofacial: Original Articles
Abstract

Background: Lip hemangiomas have traditionally been approached with expectant management. However, intervention is warranted for associated complications, including facial disfigurement, feeding difficulties, speech impairment, and psychosocial manifestations. The authors evaluated outcomes of complicated lip hemangiomas resected during the proliferative as compared with the involutional phase.

Methods: A retrospective review of patients with complicated lip hemangiomas managed with resection in the proliferative or involutional phase from 2005 to 2011 was performed. A transverse elliptical vermilion-mucosal resection technique was used. Review parameters included demographics, lesion size and location, growth phase, hemangioma-related complications, and preoperative management (corticosteroid or pulsed dye laser). Evaluated outcomes included surgical complications, recurrence, and patient- and surgeon-reported aesthetics.

Results: Twenty-one patients underwent surgical resection of a lip hemangioma (10 proliferative and 11 involutional), with a mean follow-up of 21.4 and 23.3 months, respectively. The two groups were comparable with respect to lesion size and location. Patients in the involutional group experienced higher rates of hemangioma-related complications (bleeding, 45 percent versus 10 percent; speech impairment, 82 percent versus 0 percent; feeding difficulties, 82 percent versus 20 percent; and psychosocial issues, 100 percent versus 80 percent). There were no postoperative aesthetic concerns. One recurrence in the proliferative group was treated with reresection. Speech therapy was required for 82 percent of patients in the involutional group.

Conclusions: Surgical resection is efficacious treatment for hemangiomas of the lip and yields acceptable aesthetic results during both the proliferative and involutional phases. Resection in the proliferative phase should be considered to prevent complications associated with delayed treatment.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Author Information

Vancouver, British Columbia, Canada; and Dallas, Texas

From the Division of Plastic Surgery, British Columbia Children's Hospital and University of British Columbia, and the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Received for publication May 23, 2012; accepted September 11, 2012.

Presented in part at the 16th Congress of the International Confederation for Plastic Reconstructive and Aesthetic Surgery, in Vancouver, British Columbia, Canada, May 22 through 27, 2011.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Jugpal S. Arneja, M.D., M.B.A.; Division of Plastic Surgery, British Columbia Children's Hospital, A237 Shaughnessy Building, Box 150, 4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada, jugpal.arneja@ubc.ca

©2013American Society of Plastic Surgeons