Current concepts in the classification, diagnosis and treatment of hemangiomas and vascular malformations of the head and neck

There are many different classifications of vascular anomalies. As the corr ect classification of the vascular lesion has a direct influence on therapy it is difficult to decide which treatment should be considered as the trea tment of choice. Based on an extensive review of the literature and persona l experience of the treatment of more than 200 patients with hemangiomas or vascular malformations of the head and neck, a clinical classification is described that allows vascular lesions to be categorized in order to plan p urposeful treatment. In general, hemangiomas represent the main group of va scular lesions in infancy and childhood. They are usually apparent a few we eks after birth and are characterized by an initially rapid growth of epith elial cells, followed by spontaneous involution. Hemangiomas should be diff erentiated from vascular malformations that are present at birth but may no t be evident clinically. Spontaneous involution of vascular malformations h as never been reported, whereas laser therapy can induce involution of hema ngiomas at an early stage in a majority of cases. In certain situations ste roids or surgical removal may seem to be the appropriate therapy of choice. In contrast, vascular malformations have to be treated according to their histopathology and location, as well as their hemodynamic features as shown radiographically with angiography. The accurate diagnosis of vascular anom alies is essential for further treatment, as shown by clinical experience a t the University of Marburg.