Hemangiomas are an overgrowth of small blood vessels that occurs shortly after birth. They typically have a bright red appearance and are actually a type of tumor, although not a cancer. Hemangiomas have an unusual pattern of appearing in the first few weeks after birth, growing for the first year or so of life and then fading in color and getting smaller for the next few years until they fade fully, known as involution. Sometimes they can disappear completely but often they do leave a soft bulge covered by thin papery skin where they were.
Nasal hemangiomas are particularly worrying for parents, as the bright red area is obvious on a clearly visible part of the face, and covering or hiding it is difficult. In addition, large hemangiomas can block the air passages within the nose and can distort the underlying nasal structure, which can lead to ongoing deformity even after the hemangioma has involuted.
Our approach to treating nasal hemangiomas is to use the appropriate combination of all hemangioma treatment types considering the age of the patient, and the site, size and effect of the hemangioma on the rest of the nose. We offer medical therapy such as Propranolol, different types of LASER, and surgery both to remove the swelling and to reconstruct the nose to give the overall best long-term result for the child.
In-depth look into Nasal Hemangiomas
Details of hemangiomas and treatments for them can be found in the Hemangioma page. Treating hemangiomas on the nose is more complex than in other parts of the body as they are clearly visible, they can grow to affect the air flow through the nose or grow to the side of the nose to block part of the eye’s ability to see, which is particularly worrying as even a temporary blockage of part of the area seen by one eye can affect that person’s visual development. They can also distort the underlying structure of the nose, leading to a deformity that may need nasal reconstruction.
Signs & Tests
While there are lab tests for hemangiomas, they are not normally used for diagnosis, as they require a piece of the haemangioma to be removed and sent for analysis. Diagnosis tends to be by clinical assessment both in terms of the way it has behaved up to the time of the assessment and by clinical examination.
Signs to look for are nothing or just a small red spot visible at birth, but a bright red patch that appears in the first few weeks of life, rapidly growing into a red lump over several months. After 6-12 months, it tends to stop growing and gradually turns at first purple and then grey, and it reduces in size until it has fully involuted. At this point, it may have fully disappeared but, more often, a soft lump remains with thin, papery skin overlying.
Treatment and Care
The main treatment aim for children with nasal hemangioma is to give them the best outcome in the long-term. This can sometimes involve deciding not to give any treatment and supporting the parents through the natural timecourse of the haemangioma until it has fully involuted, but most frequently for nasal hemangiomas, treatment is recommended.
Propranolol is a medication that has been used for many years to treat heart conditions in children, and it was noticed by chance in the 1990s that it caused hemangiomas in children to stop growing and to shrink back down more quickly. It is very helpful in treating nasal hemangiomas, as it makes them less obvious and helps to reduce their eventual size, which in turn reduces the chance of the hemangioma deforming the rest of the nose. For these reasons, it is likely to be recommended.
The full details of options for hemangioma treatment can be found on the hemangioma page.
Continuing to review children throughout the natural growth and shrinkage of the hemangioma is important as these can change constantly and can cause complications, which can require urgent intervention. It is also necessary to review children after the end of involution, as any lump or deformity left by the hemangioma can be addressed at the best time for the child.