Innovative and high-technology methods of treating children with vascular malformations of the tongue

Abstract

Introduction. Children with various forms of vascular malformations of the tongue are an extremely complex patient population for a number of reasons: the quality of life of the child is significantly reduced – in addition to cosmetic problems, occur functional disorders, characterized by impaired breathing, act of swallowing, chewing food, speech, the appearance of pain syndrome, the child’s social adaptation worsens; the uniqueness of each clinical case, which requires an individual approach to the treatment of a particular child; frequent combination of malformation (malformation of all types of vessels – arterial, venous, lymphatic); the absence of a clear algorithm for the diagnosis and treatment of this group of patients in the domestic and foreign literature. In this regard, the full rehabilitation of such children requires a search for optimal treatment methods, the purpose of which is to achieve a stable good functional and cosmetic result. Materials and methods. 37 children aged 1 to 17 years with lymphatic, lymphovenous, lymphoarteriovenous and venous malformations of the tongue were treated. The average age of the children was 4.7 years. In addition to general clinical data, the mandatory examination methods were – ultrasonography of pathological tissues of the head and neck, study of the blood coagulation system (thromboelastography, thrombodynamics, coagulogram), Doppler ultrasonography of the head and neck vessels, transcranial Doppler, fibrolaryngoscopy, MRI (magnetic resonance imaging) and CT (computed tomography) of the head and neck with intravenous contrast agent. All children underwent surgical treatment; 6 – puncture-sclerosing method with 3 % solution of aethoxysklerol (with venous malformation of the tongue); 9 – curly resection of the tongue and its subsequent plastic surgery with local tissues (with macroglossia in children with lymphatic, lymphovenous and lymphoarteriovenous malformations of the tongue); 31 – laser treatment (with a superficial form of lymphatic, lymphovenous and lymphoarteriovenous malformations of the tongue). It is worth noting that 9 children out of 31 who underwent laser treatment, the first stage was performed curly resection of the tongue and its subsequent plastic surgery with local tissues. Thus, 46 operations were performed on 37 children. To carry out laser treatment was used a laser apparatus LSP-»IRE-Polyus» (ЛСП-«ИРЭ-Полюс»), which allows working with two wavelengths (0.97 μm and 1.55 μm) in two modes (pulse and pulse-periodic). All operations were performed under general anaesthesia. Results. A diagnostic algorithm has been created, new methods for treating children with various forms of vascular malformations of the tongue have been developed and introduced into practice. A good result was achieved in 37 children (100 %). There were no complications. A patent for invention No. 2676832 was obtained for the method of laser treatment. The maximum observation period is 3.5 years. Conclusions. When managing patients with vascular malformations of the tongue, it is necessary to adhere to a clear diagnostic algorithm. Treatment of patients should take place in a multidisciplinary hospital and be interdisciplinary in nature. Treatment should be started immediately when complaints appear; expectant tactics are not warranted. After the treatment and the achievement of a good clinical result, dynamic monitoring of the patient is necessary.