Evaluating Excision and Reconstruction Techniques Versus Intralesional Sclerotherapy in Facial Infantile Hemangioma Management: A Clinical Outcome Study

Abstract

Background: Different therapeutic strategies exist for managing propranolol-resistant/residual infantile hemangioma (IH) in children. The effectiveness of surgical management vs sclerotherapy for treating propranolol-resistant IH located in the head and neck region is subject to ongoing discussion. The aesthetic result is also a crucial consideration. This study compares the outcomes of these treatment modalities. Methods: In this 7-year prospective study, 123 children with propranolol-resistant IH (88 females and 35 males, mean age 12.7 ± 4.37 months) were enrolled. They were randomly assigned to either surgical treatment or sclerotherapy. The effectiveness of each treatment was assessed using the Patient and Observer Scar Assessment Scale (POSAS) and by recurrence rates. Results: The surgery group showed better POSAS scores (3.58 ± 0.61 and 4.8 ± 0.77) compared to the sclerotherapy group (6.83 ± 0.79 and 7.43 ± 0.88). The recurrence rate was 4.1% in the surgery group, with no recurrences observed in the sclerotherapy group. The dropout rate was higher in the sclerotherapy group. Various surgical techniques were utilized based on the specific characteristics and locations of the lesions. Conclusion: Surgical management yields better cosmetic outcomes and comparable recurrence rates to sclerotherapy in children with propranolol-resistant IH in the head and neck region. This underscores the necessity of personalized treatment plans, with the choice of surgical technique tailored to the lesion’s characteristics. © The Association of Oral and Maxillofacial Surgeons of India 2025.