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Houston Cranio Facial


A hemangioma is a congenital vascular tumor that grows by rapid cell replication in infants.
Hemangiomas are the most common tumors of infancy and occur in 1 to 3% of infants at birth. By one year of age about 10 to 12% of babies may have a hemangioma. The good thing is that the majority of these tumors do not need to be treated and we’ll go away with time.

The typical changes seen with hemangiomas are a rapid growth phase during the first 4 to 8 months followed by plateau phase during the sixth and 12th months. This means the size is unchanged for about six months. After a year and a half the tumor will begin to shrink and disappear.

What happens next is that the skin left behind is loose and thin. For this reason surgery may be done to improve the resulting defect in normal skin. There are several other reasons to surgically removed hemangiomas:

  • Bleeding
  • ulceration
  • infection
  • visual obstruction
  • breathing airway obstruction
  • obstruction of the ear canal
  • congestive heart failure
  • emotional distress
  • Kasabach-Merritt Syndrome: low platelets

Besides surgery, our experienced craniofacial plastic surgeon utilizes medication and laser therapy. Historically steroids have been used to shrink or stop the growth of hemangiomas. Steroids were commonly given in pill form over several months. Steroids do have risks and side effects which have made them less favorable in the recent few years.

Currently the newest medication treatment involves propranolol given for about a year to stop the growth and in some instances shrink the hemangioma. Propranolol is started when the hemangioma is in the growth phase typically at 5 to 8 weeks old. Laser treatment can be used if the tumor is not resolving by about 2 years old but only after it begins to involute. This is noted when the tumor softens. The laser can be used to shrink the tumor considerably prior to surgical resection making the reconstruction easier.

Currently a combination of propanolol medication to slow or halt the growth phase can be followed by laser treatments to shrink the tumor. Combining these two methods with a final surgical resection can ultimately lead to the most optimal result.