Klinischer Verlauf und Lokalisation von venösen und arterio-venösen Malformationen der Zunge

Vascular anomalies are among the most frequent congenital malformations of soft tissues. The character of vascular anomalies is primarily defined by the involved vessel systems. A classification of vascular anomalies by Mulliken und Glowacki distinguishes between hemangiomas and vascular malformations. By definition vascular malformations already exist at birth. The tongue is a common localisation of venous and arterio-venous malformations of the head and the neck. There are surgical and conservative approaches to treat these malformations. Laser therapy plays an important role, but apart from that conventional surgery is performed. A conservative method is the “wait and see“ strategy. The aim of the present study was to analyze the localization of vascular malformations of the tongue based on schematic drawings of the tongue and to evaluate the treatment results depending on the location and size of the malformations. A retrospective analysis was performed on 43 patients who presented at the ENT department of the university Hospital of Marburg from 1998 to 2010. In this study, the vascular malformations were often detected at birth or within the first 20 years of life. The patients were classified into five groups according to the size of the vascular malformation. The first group includes small punctual lesions. The second group summarizes all patiens whose vascular malformation covers at least a quarter of the dorsum or the bottom side of the tongue on one side. A lesion on both sides of the tongue corresponds to the third group and the fourth group contains all patients whose tongue is completely affected by a vascular malformation. In group 5 you can find lesions that are located at the base of tongue. Every lesion was charted into a schema of the tongue. The distribution of malformations on the tongue was analysed by putting the schemas on top of each other. The result was a nearly uniform distribution of vascular malformations. There was no cumulative appearance along the afferent vessels which is considered as a possible explanation for the formation of vascular malformations. In many patients in whom the vascular malformations occurred later in life the edge of the front third of the tongue was affected by vascular malformations according to the first group so that they are supposed to be the result of a tongue bite. An association between the localisation of the vascular malformation and the postoperative result could not be found. In relation to the size of vascular malformations and the chance of healing it could be concluded that larger lesions were more difficult to treat and there were more residua left compared to small vascular malformations which could often be completely removed. There were partially clear differences between the groups. Laser therapy was performed most frequently. CO2-laser therapy provides a good opportunity for small vascular lesions. The Nd:YAG-laser represents a good application spectrum for small as well as larger vascular malformations but convinces especially in the treatment of large lesions. Sclerotherapy offers reliability and few complications in case it is done by a specialist. In the therapy of large lesions functional restrictions like difficulties while eating or disorder of gustatory sense have to be feared. This has to be considered before performing conventional surgery.