Facial Hamartomas in Children

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Abstract
The most common hamartomas, the neurofibroma, the lymphangioma and the hemangioma were studied. Sixteen patients with neurofibroma were evaluated, ranging in age from 11-33 yr. Since these neurofibromas are woven into the normal fabric of the face, the treatment of choice is multiple, subtotal excisions over a period of years. The results are compromised by the diffuse nature of the tumor and the tendency of the residual tumor to continue growing. A total of 106 patients with lymphangioma were evaluated. A conservative approach to treatment of lymphangiomas is advocated. Partial or complete involution occurs in 15-70% of patients during the 1st 20 yr of life. Treatment should include the following: tracheostomy, when the infant''s airway is compromised; examinations, including photographs every 6-12 mo. no operation to remove the lymphangioma until the age of at least 3 yr; and operative treatment, which should consist of partial excisions or aspiration of cysts or both. The strawberry and the port-wine hemangiomas were evaluated. Almost all of the strawberry hemangiomas will involute. Although involution was complete or almost complete by 3-7 yr of age, 2 patients showed continued slow involution, to completion at ages 14 and 18 yr. Treatment is by elliptical excision of small (1-2 cm diameter) hemangiomas, at any age, and the residual loose scarred skin left behind following involution. There is also a place for short-course, heavy-dose systemic corticosteroid therapy and compression in more massive hemangiomas. The port-wine hamangioma is present at birth and its major effect on a patient is psychological. There is no ideal treatment for this facial hamartoma, although heavy cosmetics provide a satisfactory camouflage in women.

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