Propranolol as First-line Treatment of Head and Neck Hemangiomas
Carine Fuchsmann, MD; Marie-Claude Quintal, MD; Chantal Giguere, MD; Sonia Ayari-Khalfallah, MD; Laurent Guibaud, MD, PhD; Julie Powell, MD; Catherine McCone, MD; Patrick Froehlich, MD, PhD
Objectives To report the efficacy of propranolol as first-line treatment of head and neck hemangiomas in children and to present an optimized protocol for treating hemangiomas.
Design Multi-institutional retrospective study.
Setting Two tertiary care referral pediatric centers.
Patients Thirty-nine children with head and neck infantile hemangiomas were treated.
Main Outcome Measures Review of clinical records.
Results Propranolol was the sole treatment in 60% of patients and was started at a mean age of 4.1 months (age range, 1-11 months) for early interventions among 33 of 39 patients. Propranolol therapy resulted in lightening and reduction of hemangiomas at 37 of 39 locations within 2 days to 2 weeks. One subglottic hemangioma and 1 nasal tip hemangioma did not respond or showed only a partial response; in these patients, propranolol therapy was delayed and followed other treatment failures. After successful therapeutic regression, 6 recurrences occurred; when reintroduced, propranolol was again effective. Recurrences were avoided by prolonged treatment. Twenty-six hemangiomas occurring at locations for which corticosteroid treatment previously would not have been initiated (nose, lips, and parotid area) unless a complication had occurred were treated with propranolol and were rapidly controlled. The mean duration of propranolol therapy was 8.5 months. No instances of β-blocker discontinuation because of complications occurred, but propranolol was substituted by acebutolol in 5 patients because of trouble sleeping.
Conclusions Propranolol is an effective treatment of head and neck infantile hemangiomas, especially when started early within the rapid growth phase, and is first-line treatment of orbit and larynx hemangiomas. The efficacy and tolerability of propranolol led us to treat some hemangiomas in patients whom we previously would have observed rather than subject to corticosteroid therapy. Relapse was avoided if treatment was prolonged after theoretical involution (age 12 months). Questions remain about optimal dosing and age at treatment cessation.
Author Affiliations: Service d’Otorhinolaryngologie Pédiatrique (Drs Fuchsmann, Ayari-Khalfallah, and Froehlich) and Service de Radiologie Pédiatrique (Dr Guibaud), Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, and Université Claude Bernard Lyon 1, CNRS, UMR5020 Neurosciences Sensorielles, Comportement, Cognition, Lyon (Drs Fuchsmann and Froehlich), France; and Service d’Otorhinolaryngologie Pédiatrique (Drs Quintal, Giguere, McCone, and Froehlich) and Service de Dermatologie Pédiatrique (Dr Powell), Hôpital Sainte Justine, Centre Hospitalier Universitaire Sainte Justine, Montréal, Québec, Canada.
Fuente: Arch Otolaryngol Head Neck Surg. 2011;137(5):471-478. doi:10.1001/archoto.2011.55