Infantile hemangiomas represent one of the most common childhood tumors. We have previously demonstrated that the most appropriate management for such neoplasm is conservative therapy. Some authors have recently argued for surgical management as the primary treatment. Medical treatment such as steroids or interferon therapy has also been proposed. We retrospectively reviewed the last 400 charts of hemangiomas managed at the Montreal Children's Hospital and found n=20 patients with parotid hemangioma. The average patient age at diagnosis was 3.75 months (range from 2 wks to 17 months). Five patients had other hemangiomas including the chest, upper, and lower extremity which were small and uncomplicated. The average size of the parotid hemangioma was 6.3 cm in maximal diameter (range 1 to 16 cm). There was an equal ratio of left to right side involvement and more females than males (13F:7M). All twenty of our patients underwent fully successful conservative management with 100% resolution of all parotid hemangiomas within 2 years of diagnosis with an average follow-up time of 8.6±5.7 years. Two patients received steroid treatment: the first patient developed open bleeding from the superficial lesions necessitating systemic cortisone treatment for 6 weeks which resulted in further regression of the tumor; the second patient had mild upper airway obstruction secondary to the parotid hemangioma necessitating the steroid treatment. One patient had to undergo excision of the excess skin at the age of eleven. There were no complications of any of the treatments. In conclusion, we have shown that conservative therapy should be the primary treatment of choice as it resulted in 100% resolution of the parotid hemangioma in the pediatric population. Moreover, we have developed an evidence based algorithm for the management of the pediatric parotid hemangioma.
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