23 Raluca A. Dragomir 1 , Mihai Liviu Ciofu 1 , Andrada Doscas 1 , Alexandra Carp 1 , Bogdan Dragomir 2 , Nicolae Dobrin 3 , Otilia Boisteanu 1 , Victor-Vlad Costan 1 Corresponding author: Lecturer Mihai Liviu Ciofu, MD, PhD E-mail: ciofu_mihai@yahoo.com Romanian medical JouRnal – Volume lXVii, no. 1, 2020 ABSTRACT Hemangiomas and venous malformations are frequently encountered in the head and neck region, particu- larly in children. The management of such lesions is especially difficult, considering the characteristics of the age group and the possible complications and sequelae regarding appearance and function. The high esthet- ic demands of the region, the presence of significant anatomical structures, as well as the concerns for air- way maintenance make the choice of treatment extremely challenging. The local injection of a sclerosing agent represents a minimally invasive method that is often used as a first-line treatment of such lesions. The purpose of this manuscript is to review the indications, outcomes and complications of bleomycin sclerother- apy in the treatment of vascular anomalies in the maxillofacial territory. Keywords: hemangioma, vascular anomalies, low-flow malformation, bleomycin, sclerotherapy, head and neck GENERAL ARTICLES INTRODUCTION Vascular anomalies have the greatest frequency in the head and neck areas and are often encoun- tered in children (1,2). An accurate minimally inva- sive treatment of this condition is particularly im- portant, considering the predominant age group, the potentially severe complications and debilitat- ing sequelae. According to the classification of vascular anomalies issued by the International Society for the Study of Vascular Anomalies (ISSVA), two main types of lesions make up this category – vas- cular tumors (including hemangiomas) and vascu- lar malformations (comprising high-flow and low- flow lesions, as simple or combined malformations) (1,3-5). The treatment options for vascular anoma- lies consist mainly of medication, sclerotherapy, embolization, laser therapy and surgical removal. The choice is made according to the age of the pa- tient, the size of the lesion and the expected rate of progression, the anatomical segment involved, the symptoms, as well as the presence or potential for aesthetic and functional impairment or complica- tions (2,3,6). Sclerotherapy is one of the least invasive treat- ment methods. It consists of local intralesional in- jection of a sclerosing agent and it is mainly recom- mended for hemangiomas, as well as low-flow vascular malformations, of which venous malfor- mations are the most common (1,7). From the mul- tiple known sclerosing agents, bleomycin has been increasingly used in recent studies for the conserv- ative management of head and neck vascular anom- alies (8,9). This manuscript focuses on reviewing the main uses, benefits and complications of bleomycin scle- Ref: Ro Med J. 2020;67(1) DOI: 10.37897/RMJ.2020.1.4 Management of head and neck hemangiomas and venous malformations by bleomycin sclerotherapy Article History: Received: 12 March 2020 Accepted: 26 March 2020 1 Oral and Maxillofacial Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania 2 Orthodontics and Facial Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania 3 “Prof. Dr. Nicolae Oblu” Hospital, Neurosurgery, Iasi, Romania