Department of Otolaryngology and Head Neck Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
J Oral Pathol Med. 2022 Nov;51(10):888-896. doi: 10.1111/jop.13297. Epub 2022 Apr 6.
Vascular anomalies are rare lesions of diverse nature that may affect the head and neck region. Any mass in or around the upper airway has the potential to obstruct or compromise it. The absolute priority, before etiologic treatment, is the evaluation of the risk for the airway and its management. Prenatal diagnosis of an upper airway obstruction requires a planned delivery in a center having a specialized team experienced in managing a compromised feto-neonatal airway, and who could perform an ex-utero intrapartum treatment to secure the airway. Even after birth, the airway remains central in the patient's overall management. Signs and symptoms of airway compromise must be evaluated keeping in mind the specific requirements of infants and small children and being aware that rapid worsening may occur. The treatment is then tailored to the patient and his lesion with the goal of improving symptoms while avoiding treatment-related complications. Maintaining reasonable expectations by the patient and families are part of a successful management. Cure is achievable for small and localized lesions, but symptom relief and mitigation of functional, esthetic and psychological impairments is the goal for large and complex lesions. If a tracheotomy was required, decannulation is one of the primary management goals.
血管异常是性质多样的罕见病变，可能影响头颈部。任何位于上呼吸道内或周围的肿块都有可能造成气道阻塞或损伤。在病因治疗之前，绝对的首要任务是评估气道的风险并对其进行管理。上气道阻塞的产前诊断需要在具有专门团队的中心进行计划分娩，该团队具有处理胎新生儿气道损伤的经验，并能够进行宫外产时治疗以确保气道通畅。即使在出生后，气道仍然是患者整体管理的核心。评估气道阻塞的体征和症状时必须牢记婴儿和幼儿的特殊需求，并意识到可能会迅速恶化。然后，根据患者及其病变进行治疗，目标是在避免治疗相关并发症的同时改善症状。让患者和家属保持合理的期望是成功治疗的一部分。对于小而局限的病变可以达到治愈，但对于大而复杂的病变，目标是缓解症状并减轻功能、美观和心理障碍。如果需要气管切开术，则拔管是主要管理目标之一。
