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Surgical Management Using a Modified Subunit Approach

Milton Waner, MD; Julie Kastenbaum; Kathrin Scherer, MD

Arch Facial Plast Surg. 2008;10(5):329-334.

Objectives  To study a new surgical approach to pediatric nasal hemangiomas and the need for early surgical intervention. Childhood hemangiomas are most common in the head and neck area. They can result in life-altering situations by causing airway obstruction, disfigurement, ulceration, and other adverse effects.

Design  A retrospective study of 44 consecutive patients with hemangiomas treated in our clinic during the last 9 years. The clinical characteristics of these hemangiomas are assessed and the outcome after surgery is discussed with respect to different surgical approaches. A new modified subunit approach is introduced.

Results  Based on the subunit principle, the incision line was modified to allow better access to all nasal subunits. The results using this technique were superior to the results using conventional incisions with respect to accessibility of the tumor, ability to trim excess skin after tumor removal, and aesthetic outcome. In contrast to reports in the literature, early surgical intervention is advocated as a result of this study.

Conclusions  This modified surgical technique shows superior results to the techniques used in earlier years. We strongly advocate early surgical intervention.

Author Affiliations: The Vascular and Birthmarks Institute of New York, Roosevelt Hospital, New York, New York (Drs Waner and Scherer and Ms Kastenbaum); and the Department of Dermatology, University Hospital Basel, Basel, Switzerland (Dr Scherer).

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