Clinical Outcomes of Infant with Periorbital Hemangiomas Treated with Oral Propranolol

Publication date: Available online 2 May 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Lei Xue, Chao Sun, Da-peng Xu, Zi-mei Liu, Xu-Kai Wang
PurposePeriorbital infantile hemangiomas require early intervention as they have the potential risk of causing visual disturbances. In recent years, propranolol has shown promise in the effective management of periocular and periorbital IHs. The objective of our study was to assess the clinical outcomes, efficacy, and safety of propranolol in the management of infants with high risk periorbital IHs.Patients and MethodsThis retrospective study was conducted at the Stomatological Hospital, affiliated to China Medical University. The medical records of infants with periorbital hemangiomas who were treated with systemic propranolol at a dose of 1.0-1.5 mg/kg/day between January 2014 to June 2015 were reviewed. Infants who did not qualify for propranolol treatment or, those who had previous therapy or other treatments, were excluded. The records were reviewed for treatment response, adverse events during treatment, length of treatment and recurrences. Treatment response was classified using a 4-point scale system based on reduction in volume as: poor ( <25% ), moderate ( 25-50%), good (50-75%), or excellent, (>75-100%) and change in color, and surface texture, by a panel of three plastic surgeons using two-dimensional photographs, clinical examination, and doppler ultrasonography measurements taken before and after treatment.ResultsTwenty-six out of 38 infants with periorbital hemangiomas were treated with systemic propranolol at a dose of 1.0-1.5 mg/kg taken once daily. A total of 11 males and 15 females with mean age of 5.2 months (2 to 12 months) were treated. The mean length of treatment was 22 weeks (4 to 41 weeks). Adverse events of diarrhea (n=3) and sleep changes (n=1) were encountered during treatment in 4 patients. The overall treatment response was scored as excellent (n=17), good (n=7), and moderate (n=2) patients, No patients were scored as poor, no patients required discontinuation of treatment due to adverse events, and there were no recurrences or regrowth of the tumor noted during the mean follow-up period of 6.5 months (3-10 months).ConclusionsOral propranolol 1.0-1.5 mg/kg per day (≤3 months, 1.0 mg/kg; >3 months, 1.5mg/kg) was an effective and well-tolerated dose for management of 26 Chinese infants with high risk infantile periorbital hemangiomas. Early intervention should be considered to reduce risk of visual impairment and improve aesthetic outcomes.



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