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CASO CLÍNICO
Actualidad
Médica
A C T U A L I D A D
M É D I C A
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Propranolol in the treatment of an extensive
facial and orbital infantile hemangioma: case
report
Abstract
An infantile hemangioma, a common benign vascular tumor of infancy, can cause significant visual function im-
pairment and/or relevant disfigurement. We report the successful outcome with oral propranolol treatment, with
no adverse events related to the treatment, in a 2-month-old boy who presented with a complicated extensive
infantile hemangioma of the right hemiface with deep intraorbital involvement, extending to the middle cranial
fossa and pterygopalatine fossa.
Pedro Moreira
1
, Isabel Ribeiro
1
, Marta Teixeira
2
, Isabel Martins
3
, Ana Fernandes
4
1
Department of Ophthalmology, Hospital Pedro Hispano, Porto, Portugal
2
Department of Dermatology, Hospital Pedro Hispano, Porto, Portugal
3
Department of Pediatrics and Neonatology, Hospital Pedro Hispano, Porto, Portugal
4
Department of Pediatrics, Section of Haemato-Oncology, Hospital São João, Porto, Portugal
Enviado 09-05-2013
Revisado 15-07-2013
Aceptado 26-08-2013
Pedro Moreira
Department of Ophthalmology
Hospital Pedro Hispano, Porto. Portugal
e-mail: penuna@hotmail.com
Keywords: Infantile hemangio-
ma, orbit, propranolol.
Actual. Med.
2013; 98: (789): 111-114
INTRODUCTION
Infantile hemangiomas are the most common benign
vascular tumors of infancy. It has an incidence of 1 to 3%
in newborns and 10 to 12% in children up to the first year of
life. They are more common in Caucasian children, in females
(female:male ratio of 3:1) and in premature infants (up to
30%). The diagnosis is based on clinical history and physical
examination. Most hemangiomas have an uncomplicated
benign and dynamic clinic course. C
haracteristically, they
undergo a
proliferative phase with significant growth and a
rapidly increasing size of the lesion for several months, usually
during the first year of life. After this period, there is a gradual
involution phase, with a slow spontaneous regression over
several years. It is estimated that the complete regression
occurs
at a rate of 10% per year
, so that 30% would completely regress
up to the age of 3 years, 50% up to the age of 5 years, 70% up
to the age of 7 years and 90% up to the age of 9 years. On the
other hand, an important minority of them may be associated
with significant morbidity in early childhood. The most
frequently involved regions of the body are the head and neck
(up to 60%), followed by the trunk (25%) and the extremities
(15%). Amblyopia, anisometropia, strabismus, proptosis, globe
dystopia, exposure keratopathy and compressive neuropathy
can be present in cases involving the eyelid and/or the orbit.
Therefore, problematic facial lesions can cause severe visual
impairment and/or relevant disfigurement, and require a
therapeutic intervention (
1)
.
Recently, propranolol has become increasingly popular
as a successful treatment choice for complicated infantile
hemangiomas, with few side effects comparingwith other known
therapies, namely systemic or intralesional corticosteroids,
chemotherapeutic agents (vincristine, cyclophosphamide,
alpha-interferon), radiotherapy, laser therapy, embolization,
surgical intervention or a combination of treatments (
2-4)
.
CASE REPORT
A 2-month-old boy was examined for an expansive
hemangioma of the right hemiface, involving the subcutaneous
tissue with superficial repercussion on the malar region and
near the labial commissure. He had experienced progressive
painless proptosis, superior and lateral displacement of the
right ocular globe, along with fullness of the inferior eyelid for
1 month (figure 1).
Figure 1. 2-months-old boy, before treatment.