Primary Surgical Excision of Venous Malformations of the Head and Neck: Subsequent Management and Outcomes

Objectives: (1) Discuss primary surgical excision of head and neck venous malformations (VMs) and possible need for subsequent therapy. (2) Describe outcomes of primary surgical excision of VMs of the head and neck. Methods: We conducted a retrospective chart review of 45 patients (23 females and 22 males) treated with primary surgical excision of head and neck VMs who presented between 2001 and 2012 to a tertiary pediatric academic institution with a multi-disciplinary vascular anomalies center. Results: Mean age at presentation was 10.2 years, with a higher average age for female patients (11.7 years) than male patients (8.6 years). The most common anatomical subsites were the face/cheek (22.2%), neck (17.8%), and lower lip (11.1%). A majority of patients (73.3%) experienced significant improvement after the initial excision, though 42.2% of patients ultimately required subsequent treatments (either repeat excision, laser therapy, or sclerotherapy) to obtain overall disease control. The majority of patients (57.8%) required only the initial surgical excision for adequate treatment. Few patients experienced postoperative complications. The most common patient complaint was transient postoperative edema. The main outcome measures included need for subsequent treatments after excision, overall improvement (significantly decreased size or resolution of VM and decreased pain) postoperatively, and postoperative complication rate/patient complaints. Conclusions: Venous malformations of the head and neck are uncommon. However, when appropriately selected for surgical excision, most do not require subsequent treatment for disease control. We present a series of 45 patients who were treated with primary surgical excision, 57.8% of whom required no further treatment.