Comparative Analysis of Intralesional Sclerotherapy with Sodium Tetradecyl Sulfate Versus Bleomycin in the Management of Low Flow Craniofacial Soft Tissue Vascular Lesions

Abstract

Objective Comparison of the efficacy of bleomycin over sodium tetradecyl sulfate (STS) when given intralesionally in the treatment of oral and maxillofacial venous malformation. Methods 16 patients with venous malformation in craniofacial region were randomly divided into two groups of eight. Group 1 was given intralesional injection of bleomycin and group 2 was injected with STS. All the cases were evaluated for a minimum period of two and a maximum of 3 years. Results Efficacy of bleomycin was found to be superior to STS, when used as intralesional sclerotherapic agent. Most of the vascular lesions of group 1 resolved after first dose giving a cure rate of 87.5% and no recurrence was observed. Group 2 patients however, required 4-6, a mean of five repeated dosage of intralesional STS before their lesions started to resolve and three patients reported with recurrence within 2 years, giving an overall effective response rate of 62.5%. Conclusion Bleomycin under selected conditions appears to be an excellent therapy for treating soft tissue vascular lesions of low flow nature in craniofacial region. Predictable results were obtained with a high success rate. No systemic or pulmonary complications occurred.

Foamed bleomycin sclerosis of airway venous malformations: The role of interspecialty collaboration

“…The published imaging and clinical ORR for VMs of the head and neck treated with bleomycin percutaneous sclerotherapy range from 65% to 100% . The ORR in our case series (87.5%) was similar.…”

“…Our 50% complication rate, all of which were grade I or II, seems high in comparison. However, structures outside the airway represent the majority of head‐and‐neck bleomycin VMPS treatment sites in the published literature . All four of our complications after bleomycin sclerotherapy involved the oral cavity.…”

“…Bleomycin A2 is the most commonly used form in the United States. Both bleomycin A2 and A5 have been used to treat VMs . Bleomycin A5, also known as pingyangmycin , in particular has a long history of clinical use, particularly in China…”

“…However, structures outside the airway represent the majority of head-and-neck bleomycin VMPS treatment sites in the published literature. 21,22,28,35,36,[38][39][40][41][42][43][44][45][46][47][48][49] All four of our complications after bleomycin sclerotherapy involved the oral cavity. This may indicate a higher complication rate after bleomycin sclerotherapy in the oral cavity or other airway structures.…”

Bleomycin‐induced flagellate erythema after venous malformation sclerosis—Case report and brief review

“…Sodium tetradecyl sulphate is another commonly used sclerosant and is considered the first choice for VM treatment in many centers . Nevertheless, Bajpai and colleagues reported that sodium tetradecyl sulphate is less effective than bleomycin and that complications, although minor, occur more frequently.…”