Infantile hemangiomas commonly involve the nose. Because of the nose’s prominence as an aesthetically and functionally sensitive area, management of these lesions has important implications. The available options including medical therapy, lasers, and surgery are reviewed with recommendations specific to nasal tip and lobule lesions based on the senior author’s (M.H.) experience.
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Proliferating compound hemangioma of the nasal tip before (A) and after (B) pulsed-dye laser treatments to the superficial component and early involution of the deep component.
Thick superficial hemangioma of the nasal margin and lobule before (A) and after (B) pulsed-dye laser treatments. Surgical touch-up of the nostril margin may be performed after observation for further involution.
Massive compound hemangioma of the hemiface before (A) and after (B) treatment with systemic corticosteroids, laser, and surgical treatments. Over the course of 7 operations, the child’s facial features were uncovered and a nasal shape sculpted. Auricular cartilage grafts were used in anatomic and nonanatomic areas for support.
Intraoperative management of a compound hemangioma of the nasal tip in late proliferation previously treated with the pulsed-dye laser. Preoperative view (A). The proposed skin incisions (B) are carried along the columellar edges and above the nostril margin (C). A plane of dissection is created between the superficial and deep components of the lesion, and the soft tissue envelope is undraped (D). A natural plane is meticulously developed between the deep component of the hemangioma and the intact lower lateral cartilages and superior septum (E and F). The abnormal, redundant skin is resected through incisions tailored to the demands of the case (G-J). Early final result at approximately 4 years (K).
Compound hemangioma of the nasal tip before (A) and 6 years after (B) surgical resection.
Compound hemangioma of the nasal tip and lateral sidewall presenting during involution. The skin is scarred from ulceration during proliferation. Preoperative view (A, D, and F). One-year (B) and 2-year (C, E, G, and H) follow-up after surgical resection and treatment of the residual superficial telangiectasias with the pulsed-dye laser. On the lateral view (G), note placement of the incision along the alar groove and later nasal sidewall. On the basal view (H), note the incision bordering the soft triangle in contradistinction to those used in the traditional open approach.
Involuting compound hemangioma of the alar lobule, lateral wall, and medial cheek. Preoperative view (A). This lesion was obstructing the nasal airway at the level of the nasal valve. The intranasal portion of the lesion was resected at a separate procedure to not risk loss of vestibular lining. Intraoperative views of the external resection and repositioning of the lobule (B and C). No bracing cartilage grafts were used in the lobule at this stage. Early postoperative result prior to further pulsed-dye laser treatments (D). Further definition of the medial cheek-nasofacial junction will occur with further involution, or if needed, by surgical resection.
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