ORIGINAL ARTICLE
Management of Head and Neck Hemangiomas in Adults: Oral
Propranolol Versus Oral Itraconazole in Conjugation
with Injection Sodium Tetra Decyl Sulphate
Siddharth Panditray
1
•
Sauvagini Acharya
1
•
Nilamadhab Prusty
1
•
Subha Saumya Dany
2
Received: 9 January 2018 / Accepted: 22 May 2018
Ó Association of Otolaryngologists of India 2018
Abstract Management of head and neck hemangiomas with
oral propranolol versus oral itraconazole in conjugation with
injection sodium tetra decyl sulphate. This prospective par-
allel clinical trial was done to check for the effectiveness of
oral propranolol and oral itraconazole when used in conju-
gation with inj. sodium tetra decyl sulphate in treatment of
head and neck haemangiomas in adult patients visiting
department of ENT and head and neck surgery, VIMSAR,
Burla. All the patients visiting the department with heman-
gioma (diagnosed clinically and by FNAC) were considered
and only those who gave written informed consent and were
according to our inclusion and exclusion criteria were inclu-
ded into the study as subjects. Dimension (length, width and
hemi-circumference) of the haemangiomas were measured
using disposable paper taper measures. Depth of the heman-
gioma was calculated based on formula and using that volume
was calculated both at baseline and after 8 weeks of drug
administration. Data so collected was entered into Microsoft
Office Excel 2013 and statistical analysis was performed
using SPSS Version 20.0. Descriptive statistics was calculated
and student’s t test (paired and unpaired) was used to compare
within the group (before and after) and between the groups
respectively. Statistical significance was set at p B 0.05. Both
the groups showed statistically significant volume reduction
in the lesions [p \ 0.018 (propranolo ? sodium tetra decyl
sulphate), p \ 0.025 (itraconazole ? sodium tetra decyl
sulphate)]. The mean decrease in volume in propranolol group
was 91.92% and that in itraconazole group was 88.97%. There
was no statistical difference between the final outcome of both
the groups (p \ 0.766) but 3 patients on propranolol had
complete resolution while 1 patient on itraconazole had
complete resolution of the lesion. Oral propranolol and itra-
conazole are both effective and safe in hemangioma in adults.
The combination with inj. sodium tetra decyl sulphate has a
(1) favorable impact on decreasing the overall duration of
treatment. (2) Aiding in complete resolution of lesions
(especially \ 3 cm). Propranolol has an edge over itracona-
zole (more no of tumors had complete resolution).
Keywords Hemangiomas Á Propranolol Á Itraconazole Á
Sclerotherapy
Introduction
Haemangiomas are benign vascular tumors, most com-
monly appearing in head and neck region of the body,
found mostly in infants. The true incidence is unknown [1].
Most of them occur sporadically, although an autosomal
dominant pattern of inheritance has been reported [2]. The
vast majority of these malformations are sporadic and more
commonly occur in the mouth, airway tract and muscle [3].
There are many treatment modalities reported in the
literature for head and neck haemangioma, including wait
and see policy, drug therapy, sclerotherapy (steroids,
bleomycin), cryotherapy, isotope radiotherapy, laser ther-
apy, and surgical therapy. Controversies exist regarding the
choice of therapy on an individual basis.
The aim of treatment is to counter the proliferative growth,
reduce the volume of haemangioma, and initialize the process
of regression. Many drug trials have been conducted for oral
therapy on infantile forms of haemangioma but not many
& Siddharth Panditray
siddoc786@gmail.com
1
Department of ENT and Head Neck Surgery, VSSIMSAR,
Burla, Odisha 768017, India
2
Department of Dental Surgery, VIMSAR, Burla, Odisha
768017, India
123
Indian J Otolaryngol Head Neck Surg
https://doi.org/10.1007/s12070-018-1410-8
@Phil_Robichaud
@deepthiw
@JoseServera