Efficacy Evaluation Of Oral Propranolol For Head And Neck Infantile Hemangioma

Background:Infantile hemangioma (IH) is considered as the most common vascular tumor of childhood and infancy with prevalence as high as 10%, most of which are located on head and neck(60%). The majority of these lesions can spontaneous regress without intervention. Many patients suffer permanent damage from scarring or from deposition of fibrofatty residuum. Take cosmetic risks into consideration, IHs particularly in the head and neck need to be intervened as soon as possible. Leaute-Labreze C et al. in 2008 first reported that propranolol inhibits the growth of IHs in children. From then, lots of reports have demonstrated the efficacy and safety of propranolol for the treatment of hemangioma. Propranlol have become the first-line agent for hemangioma.Objectives:1.We performed this retrospective study to evaluate the therapeutic response of propranolol in infants with IHs of head and neck region;2.To identify favorable prognostic factors for treatment of IHs.Methods:1. This study was conducted in department of oral and maxillofacial surgery of Qilu Hospital, Shandong University in the period between June 2009 and December 2015. We select patient according to the inclusion and exclusion criteria;2.The patients of our study are all treated with oral propranolol. Type and location of lesions, age at initiation of treatment, treatment duration and adverse effects were recorded. The therapeutic responses were evaluated after a 6-months treatment. The therapeutic responses were categorized into four grades (Ⅰ, Ⅱ, Ⅲ, IV) base on the Achauer system. We take grade Ⅲ and grade Ⅳ as the effective rate;3.We analyze the effect of type and location of lesions, age at initiation of treatment on the therapeutic response and treatment duration of propranolol.Results:1.The therapeutic response were classed as grade IV inlll patients (66.1%) patients, grade Ⅲ in 41 patients (24.4%) patients, grade Ⅱ in 11 patients (6.5%) patients and grade Ⅰ in 5 patients (3.0%) after 6-month treatment. And average duration of treatment was 9.65 (2-24) months;2.The patients at early initiation always have poor therapeutic response and long duration than the older ones. The 7-9 months old group with a higher (95.3%) therapy response and shorter (8.24 months) duration than the other age groups;3.The therapeutic response of the deep (95%) is better than that of the superficial (93.3%) and the mix (89.5%), but the duration of deep lesions (11.55months) is longer than the superficial (10.27months) and the mix (9.30months);4.The therapeutic responses among different locations vary wildly. The parotid, periorbital, cheek and neck have better response than the other locations of head and neck. The duration of periauricular, neck and oral mucosa exceed 11 months, which are longer than the other locations.Conclusions:1. Oral propranolol has significant effect for head and neck IHs;2. The deep and superficial lesions can take oral propranolol as mainstay, with other therapies as supplementary;3. For IHs in the region of forehead and nose, which was less sensitive to propranolol, and those in the region of oral mucosa, ear, neck which usually take longer duration in treatment, multi therapeutic strategies are recommended.