Treatment of facial haemangiomas: the present status of surgery

Although conservative management is usually proposed for haemangiomas occurring in infancy, the presence of these tumours on the face may result in severe complications and provide an indication for treatment. In this paper, we report 35 patients who underwent surgical treatment for facial haemangiomas. The series consists of 23 females and 12 males, ranging in age from 2.5 months to 35 years. In six patients early surgery, before the age of 2 years, was performed because of severe complications, including visual occlusion, repeated bleeding and distortion of adjacent structures. In 16 children surgical resection of haemangiomas was carried out between 2 and 5 years of age, before complete involution. In 13 patients persisting haemangiomas were surgically treated at an older age. The operative technique depended on the location and size of the lesion, and focused on resection of the tumour and reconstruction of the adjacent structures when necessary. The postoperative outcomes were very satisfactory. Early surgery is mandatory in the management of large periocular haemangiomas, to prevent secondary amblyopia, and proliferative labial tumours, which are prone to bleeding and cause difficulty while eating. Early surgical treatment is also recommended for nasal-tip haemangiomas, which regress very slowly and may result in severe distortion of the cartilaginous framework. In conclusion, facial haemangiomas causing functional disturbance or serious psychological distress deserve surgical excision before the age of expected spontaneous regression; surgery can provide active treatment with excellent results and minimal morbidity.