Relevance. Congenital malformations of blood vessels (angiodysplasia) occur in 1.5% of newborns, while up to 70% of them are accounted for by venous angiodysplasias. [2] To date, there is no single generally accepted algorithm for the diagnosis of venous angiodysplasias /Irrational dispensary observation of this group of patients often reduces to zero the effectiveness of the treatment.
Purpose. Improving the methods of diagnosis and treatment of angioplasty of maxillofacial region in children.
Tasks. To develop an algorithm of measures aimed at diagnosing this pathology, sizing, topography, angioarchitecture, hemodynamic parameters of venous angiodysplasia. To offer rational methods of dynamic observation of this category of patients.
Materials and methods. In the period from October 2017 to September 2018, 30 children diagnosed with venous angiodysplasia were observed in the Center for Surgery and Dentistry and MGSU.
Distribution of children by age and sex:
|
Age |
0-3 |
3-7 |
7-12 |
12-17 |
total |
|
The boys |
1 |
2 |
3 |
4 |
10 |
|
Girls |
2 |
3 |
5 |
10 |
20 |
|
Total |
3 |
5 |
8 |
14 |
30 |
As follows from the table, according to gender, the quantitative composition was divided as follows: with this pathology, girls were observed exactly 2 times more often than boys.
table 2 - Distribution of venous angiodysplasia by localization:
|
Anatomical region |
n |
% |
|
|
Cheek area, lower lip |
8 |
6.6 |
2 |
|
Parotid chewing, cheek area |
11 |
6.6 |
3 |
|
Upper lip |
6 |
0 |
2 |
|
Tongue, floor of mouth |
3 |
0 |
1 |
|
Tongue, floor of mouth, lower lip |
2 |
6 |
6. |
|
Total |
30 |
00 |
1 |
The results of the study. After the clinical examination, all patients who underwent an ultrasound examination were performed with color Doppler mapping. According to our observations, this method should be the primary link in the diagnosis of this pathology in children, because it has several advantages: it is non-invasive, does not require special preparation of the patient and anesthesia. Also, echography combined with color Doppler mapping is quite informative for this pathology: it allows not only to identify the vascular component of the neoplasm, but also to determine the nature of blood flow, angioarchitecture, linear, volumetric blood flow velocity and its intensity. An ultrasound examination of venous angiodysplasia also made it possible to detect the presence of cavities, which increase sharply in volume when performing compression tests. The echographic signs of blood clots, including signs of organization, and phleboliths were determined. When performing the CDC in all 30 patients in the lesion, a great number of dilated vessels with low blood flow rates (up to 10 cm / sec) were detected. In 4 patients, isolated vessels with moderately high linear blood flow velocity (up to 20 cm / sec) were detected.
Despite the above-mentioned advantages, we have found that when making a diagnosis of “venous angiodysplasia,” regardless of the location and extent of the lesion, an MRI scan is necessary. This is due to the fact that only by MRI we were able to reliably estimate the true volume of venous hyperemia in the tissues, visualize the exact number of calcinates and phlebolites. The obtained value allowed to calculate the exact volume of the input sclerosant. The main advantages of MRI before treatment should include the possibility of further objective monitoring of the effectiveness of treatment. We performed MRI after every second session of sclerotherapy for venous angiodysplasia at least 5 weeks after the procedure.
Findings. The primary link in the diagnosis of venous angiodysplasias in children, regardless of age, is ultrasound with color Doppler mapping, in view of the ease of its implementation, the lack of need for special patient preparation and high informativeness of the method. However, after verification of the diagnosis, an MRI scan should be carried out regardless of the location and extent of the process.
Bibliography.
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- Дан, В.Н. Возможности компьютерной томографии в диагностике ангиодисплазий и выборе хирургической тактики / В.Н. Дан, Г.Г. Кармазановский, К.М. Нарлыев // Хирургия. – 1994.
- Иванов, А.В. Клиника, диагностика и лечение детей с врожденными ангиодисплазиями в форме артерио-венозных коммуникаций с поражением лицевого скелета: дисс. … канд. мед. наук: 14.01.14/ Иванов Александр Викторович –М., 2006.
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