AUTHOR=Benoiton Lara A. , Chan Kenneth , Steiner Frederica , FitzJohn Trevor , Tan Swee T. 

TITLE=Management of Orbital and Periorbital Venous Malformation

JOURNAL=Frontiers in Surgery

VOLUME=4

YEAR=2017

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2017.00027

DOI=10.3389/fsurg.2017.00027

ISSN=2296-875X

ABSTRACT=<sec id="ST1"><title>Background</title><p>To review our management of common venous malformation (VM) affecting the orbit and/or periorbital area.</p></sec><sec id="ST2"><title>Methods</title><p>Consecutive patients with orbital and/or periorbital VM were identified from our vascular anomalies database. Demographic details of the patients, anatomic site(s) affected, symptoms and signs, presence of a family history of VM, and types of treatment(s) were collected, supplemented by chart review.</p></sec><sec id="ST3"><title>Results</title><p>A total of 24 patients’ age 1–68 (mean, 30) years with orbital and/or periorbital VM presented with cosmetic concerns (<italic>n</italic> = 17, 71%), distensibility (<italic>n</italic> = 15, 63%), pain (<italic>n</italic> = 9, 38%), diplopia (<italic>n</italic> = 4, 17%), and spontaneous thrombosis (<italic>n</italic> = 1, 8%). The VM caused globe dystopia (<italic>n</italic> = 13, 54%), enophthalmos (<italic>n</italic> = 6, 25%), proptosis (<italic>n</italic> = 3, 12%), exotropia (<italic>n</italic> = 3, 12%), and pseudoptosis with visual obstruction (<italic>n</italic> = 3, 13%). A total of 11 (46%) patients were managed conservatively. 13 (54%) patients underwent active treatment. Ethanol sclerotherapy (ES) was performed in six patients with extensive facial VM associated with orbital/periorbital involvement, resulting in symptomatic improvement in five patients, one of whom developed skin necrosis and another patient developed reduced infraorbital nerve sensation. Surgery was performed for localized lesion (<italic>n</italic> = 3, 23%), for extensive lesions (<italic>n</italic> = 4, 31%) and as an adjunct to ES (<italic>n</italic> = 6, 46%) resulting in symptomatic improvement in all patients. One patient required correction of lower lid ectropion.</p></sec><sec id="ST4"><title>Conclusion</title><p>Orbital and/or periorbital VMs are heterogeneous, and management needs to be individualized. Surgery is used for localized lesions aiming for complete excision, as a debulking procedure for extensive orbital/periorbital VM when ES was not possible, or following ES for extensive facial VM with orbital and/or periorbital involvement.</p></sec>