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Ciruga Oral y Maxilofacial Universidad El Bosque

CAROLINA GAMBOA HERNANDEZ

Tumor vascular benigno, las lesiones mas comunes en cabeza y cuello, generalmente asintomticas

Aarn H. Baer, MDa, Hemant A. Parmar, MDa. Hemangiomas and Vascular Malformations of the Head and Neck: A Simplified ApproachNeuroimag Clin N Am 21 (2011) 641658

Primer caso Liston 1843 Kasabach & Merrit 1940 tejido blando Mulliken & Glowaki 1982 verdadera neoplasia Douglas Marchuk 2001 estadios de el Hemangioma Danielle A Katz proliferacin anormal de de vasos sanguneos

Mulliken & Glowaki 1982


I- HEMANGIOMA II-MALFORMACIONES VASCULARES a- bajo flujo b- alto flujo III- MALFORMACIONES LINFATICAS

Aaron H. Baer, MDa, Hemant A. Parmar, MDa. Hemangiomas and Vascular Malformations of th eHead and Neck: A Simplified Approach Neuroimag Clin N Am 21 (2011) 641658

Tumor Infantil mas comn en cabeza y cuello. 1-2 % neonatos 5:1 nias N 10-12% en raza blanca y mayor en nacidos prematuros 80% lesin solitaria 20% mas de 5 lesiones Edad avanzada; placenta previa

Aaron H. Baer, MDa, Hemant A. Parmar, MDa. Hemangiomas and Vascular Malformations of th eHead and Neck: A Simplified Approach Neuroimag Clin N Am 21 (2011) 641658 Larry D. Hartzell, MD, Lisa M. Buckmiller, MD Current Management of Infantile Hemangiomas and Their Common Associated Conditions Otolaryngol Clin N Am 45 (2012) 545556

Blanda a la palpacin

NAumento de Temperatura

Pulstil Murmullo a la auscultacin

Aaron H. Baer, MDa, Hemant A. Parmar, MDa. Hemangiomas and Vascular Malformations of th eHead and Neck: A Simplified Approach Neuroimag Clin N Am 21 (2011) 641658 Larry D. Hartzell, MD, Lisa M. Buckmiller, MD Current Management of Infantile Hemangiomas and Their Common Associated Conditions Otolaryngol Clin N Am 45 (2012) 545556

Telangiectasia Mcula rosada o violcea Crecimiento Crecimiento intermitente 1 ao


N

Aaron H. Baer, MDa, Hemant A. Parmar, MDa. Hemangiomas and Vascular Malformations of th eHead and Neck: A Simplified Approach Neuroimag Clin N Am 21 (2011) 641658 Larry D. Hartzell, MD, Lisa M. Buckmiller, MD Current Management of Infantile Hemangiomas and Their Common Associated Conditions Otolaryngol Clin N Am 45 (2012) 545556

PROLIFERATIVO 4-18meses

Alta actividad mittica

INACTIVO

Disminucin de la celularidad

CAMBIOS DE TONALIDAD INVOLUCION 6-10 aos


Aaron H. Baer, MDa, Hemant A. Parmar, MDa. Hemangiomas and Vascular Malformations of th eHead and Neck: A Simplified Approach Neuroimag Clin N Am 21 (2011) 641658

FASE PROLIFERATIVA Dermis y tejido celular subcutneo compuesto por lbulos y capilares de gran tamao Clulas endoteliales de gran tamao Mnimo estroma intervascular Pocos fibroblastos Gran actividad mittica

FASE INVOLUCION Disminucin en el numero de capilares Aplanamiento de las clulas endoteliales Disminucin de la actividad mittica Aumento del estroma fibroso Aumento de contenido fibrograso

North

GLUT 1

Antes del nacimiento. 3% NO GLUT-1

RICH Rpidamente 1 meses

NICH

Aaron H. Baer, MDa, Hemant A. Parmar, MDa. Hemangiomas and Vascular Malformations of th eHead and Neck: A Simplified Approach Neuroimag Clin N Am 21 (2011) 641658

SUPERFICIAL Dermis Lesiones rojabrillante

MIXTO

PROFUNDO Tejido celular subcutneo /conectivo

60 % Cabeza y Cuello

FRENTE MEJILLAS ORBITA/PERIORBITA LABIOS CAVIDAD NASAL LARINGE ESPACIOS PROFUNDOS CUELLO

20 % Tronco

15 % Extremidades

Aaron H. Baer, MDa, Hemant A. Parmar, MDa. Hemangiomas and Vascular Malformations of th eHead and Neck: A Simplified Approach Neuroimag Clin N Am 21 (2011) 641658

Kristen E. Holland, MDa,*, Beth A. Drolet, MDb Infantile Hemangioma, Pediatr Clin N Am 57 (2010) 10691083

24%
Ulceracin

Patrn mixto
Dolor infeccin sangrado cicatriz

Kristen E. Holland, MDa,*, Beth A. Drolet, MDb Infantile Hemangioma, Pediatr Clin N Am 57 (2010) 10691083

Kristen E. Holland, MDa,*, Beth A. Drolet, MDb Infantile Hemangioma, Pediatr Clin N Am 57 (2010) 10691083

Ecografa : alto y bajo flujo Resonancia Magntica isointensidad en t1, hiperintensidad en t2


Tomografa Computarizada Angiografa evaluacin de vaso nutriente y drenaje no relacin con estructuras vecinas

Aaron H. Baer, MDa, Hemant A. Parmar, MDa. Hemangiomas and Vascular Malformations of th eHead and Neck: A Simplified Approach Neuroimag Clin N Am 21 (2011) 641658

Tienes similares caractersticas

Hemangioma Congnito Trombos intravasculares

Hemangioma Infantil Componente venoso

Aaron H. Baer, MDa, Hemant A. Parmar, MDa. Hemangiomas and Vascular Malformations of th eHead and Neck: A Simplified Approach Neuroimag Clin N Am 21 (2011) 641658

Involucin espontanea. Control peridico


rea anatmicas comprometidas Rata de crecimiento

Implicaciones estticas
Deformidad facial

Aaron H. Baer, MDa, Hemant A. Parmar, MDa. Hemangiomas and Vascular Malformations of th eHead and Neck: A Simplified Approach Neuroimag Clin N Am 21 (2011) 641658

PIGMENTACION PERMANETE

CICATRIZ

OCUPACION POR TEJIDO FIBROGRASO

Aaron H. Baer, MDa, Hemant A. Parmar, MDa. Hemangiomas and Vascular Malformations of th eHead and Neck: A Simplified Approach Neuroimag Clin N Am 21 (2011) 641658

VIA AEREA

Larry D. Hartzell, MD, Lisa M. Buckmiller, MD Current Management of Infantile Hemangiomas and Their Common Associated Conditions Otolaryngol Clin N Am 45 (2012) 545 556

V1-V2

P H A C E S

POSTERIOR CRANIAL FOSSA N HEMANGIOMAS ARTERIAL ABNORMALITIES CARDIAC ABNORMALITIES EYES

STERNAL CLEFTING

Aaron H. Baer, MDa, Hemant A. Parmar, MDa. Hemangiomas and Vascular Malformations of th eHead and Neck: A Simplified Approach Neuroimag Clin N Am 21 (2011) 641658 Larry D. Hartzell, MD, Lisa M. Buckmiller, MD Current Management of Infantile Hemangiomas and Their Common Associated Conditions Otolaryngol Clin N Am 45 (2012) 545556

ULCERACION
Cuidado local de herida/ Debridamiento Compresas hmedas con soluciones de acetato de aluminio Domeboro solution [Bayer Health care, Morristown, NJ, USA). Antibioticos tpicos

CORTICOESTEROIDES ORALES 70-90 % RESPUESTA PREDNISOLONA Dosis de 2 a 5 mg/kg/d por 1 mes, 0,5 mg Irritabilidad, trastornos sueo, fascies cushing, supresin adrenal; inmunosupresin cardiomiopata

Aaron H. Baer, MDa, Hemant A. Parmar, MDa. Hemangiomas and Vascular Malformations of th eHead and Neck: A Simplified Approach Neuroimag Clin N Am 21 (2011) 641658
Kilcline C, Frieden IJ. Infantile hemangiomas: how common are they? A systematicreview of the medical literature. Pediatr Dermatol 2008;25(2):16873

Arin K. Greene, MD, MMSc Management of Hemangiomas and other Vascular Tumors Clin Plastic Surg 38 (2011) 4563

CORTICOESTEROIDES INTRALESIONALES
Lesiones pequeas bien delimitadas Propiedades anti-angiognicas.

Inhibicin acido araquidonico


Triamcinolona 3 mg/kg sesin

Aaron H. Baer, MDa, Hemant A. Parmar, MDa. Hemangiomas and Vascular Malformations of th eHead and Neck: A Simplified Approach Neuroimag Clin N Am 21 (2011) 641658
Kilcline C, Frieden IJ. Infantile hemangiomas: how common are they? A systematicreview of the medical literature. Pediatr Dermatol 2008;25(2):16873

Arin K. Greene, MD, MMSc Management of Hemangiomas and other Vascular Tumors Clin Plastic Surg 38 (2011) 4563

leurocristina, alcaloide- oncolitico

Derivado de la planta Catharanthus Roseus


Dosis semanal de 1 a 1,5 mg/kg va central

Constipacin, neuromiopatia

Kilcline C, Frieden IJ. Infantile hemangiomas: how common are they? A systematicreview of the medical literature. Pediatr Dermatol 2008;25(2):16873. Kristen E. Holland, MDa,*, Beth A. Drolet, MDb Infantile Hemangioma, Pediatr Clin N Am 57 (2010) 10691083

PROPANOLOL
1 a 3 mg/kg /d dividido 2-3 tomas Control con ekg 3 semanas

Kilcline C, Frieden IJ. Infantile hemangiomas: how common are they? A systematicreview of the medical literature. Pediatr Dermatol 2008;25(2):16873. Kristen E. Holland, MDa,*, Beth A. Drolet, MDb Infantile Hemangioma, Pediatr Clin N Am 57 (2010) 10691083

Larry D. Hartzell, MD, Lisa M. Buckmiller, MD Current Management of Infantile Hemangiomas and Their Common Associated Conditions Otolaryngol Clin N Am 45 (2012) 545556

Larry D. Hartzell, MD, Lisa M. Buckmiller, MD Current Management of Infantile Hemangiomas and Their Common Associated Conditions Otolaryngol Clin N Am 45 (2012) 545556

Inhibidor de angiogenesis

Subcutneo 3 millones m2/dia


Fiebre ,irritabilidad, malestar general, neutropenia, parlisis cerebral

Kilcline C, Frieden IJ. Infantile hemangiomas: how common are they? A systematicreview of the medical literature. Pediatr Dermatol 2008;25(2):16873. Kristen E. Holland, MDa,*, Beth A. Drolet, MDb Infantile Hemangioma, Pediatr Clin N Am 57 (2010) 10691083

PULSE DYE LASER


Disminucin del tamao de la lesin establecida Uso en hemangiomas en etapa proliferativa??

Ulceracin / cicatriz Limitacin 0.7 a 1.2 mm de profundidad de la lesin

Kilcline C, Frieden IJ. Infantile hemangiomas: how common are they? A systematicreview of the medical literature. Pediatr Dermatol 2008;25(2):16873. Kristen E. Holland, MDa,*, Beth A. Drolet, MDb Infantile Hemangioma, Pediatr Clin N Am 57 (2010) 10691083

Alcohol absoluto 96%


Desnaturalizacin de protenas del endotelio vascular, trombosis del lecho vascular Infiltracin de la lesin en centmetros cbicos Lesiones menores de 10 cm

Kilcline C, Frieden IJ. Infantile hemangiomas: how common are they? A systematicreview of the medical literature. Pediatr Dermatol 2008;25(2):16873. Kristen E. Holland, MDa,*, Beth A. Drolet, MDb Infantile Hemangioma, Pediatr Clin N Am 57 (2010) 10691083

Introduccin teraputica de varias sustancias en la circulacin para ocluir vasos, controlar o evitar hemorragias, desvitalizar una estructura o tumor u rgano y reducir el flujo de sangre de una malformacin arteriovenosa

merland j. superphicial and peripheral vascular malformations.role of interventional radiology and embolization. j. mal. vasc.1992; 17:44-9

METAS TERAPEUTICAS:

Coadyuvante (quimioterapia y radioterapia) Curativo (aneurismas, fstulas arteriovenosas, malformaciones arteriovenosas, hemangiomas y sangrados traumticos)

Tratamiento Prequirrgico: disminuye necesidad de transfusiones

Merland j. superphicial and peripheral vascular malformations.role of interventional radiology and embolization. j. mal. vasc.1992; 17:44-9

MATERIALES NO REABSORVIBLES: ETANOL ALCOHOL DE POLIVINILO (PVA) MICROESFERAS TAPONES VASCULARES-COILS


REABSORVIBLES: GELFOAM
MERLAND J. SUPERPHICIAL AND PERIPHERAL VASCULAR MALFORMATIONS.ROLE OF INTERVENTIONAL RADIOLOGY AND EMBOLIZATION. J. MAL. VASC.1992; 17:44-9

10%
Correccin esttica Mejorar cicatriz, tejido fibrograso, piel redundante

Kilcline C, Frieden IJ. Infantile hemangiomas: how common are they? A systematicreview of the medical literature. Pediatr Dermatol 2008;25(2):16873. Kristen E. Holland, MDa,*, Beth A. Drolet, MDb Infantile Hemangioma, Pediatr Clin N Am 57 (2010) 10691083

Falla o contraindicacin a terapia farmacolgica Adecuada localizacin; seguridad

No requerimiento reconstructivo