Vascular Lesions of the Head and Neck

Review by L M Flood
Middlesborough, UK

Now, here is an essential read for those facing exit exams in our field, even if they will not immediately appreciate that.  If we are to be honest, other than the select few who opt for the demanding career of paediatric otolaryngology, most of us will never again need to delve into this textbook, after completion of training.

Or so I thought. The title, to me anyway, suggested the baby with the bluish swollen parotid, the infant with the red lump encroaching onto the corner of the eye or the smooth swelling (curiously always on the left) in the subglottis, causing early onset stridor. These are the topics that have come up in every single FRCS exam, in someone’s paediatric viva. The discussion will then centre on arteriovenous malformation vs haemangioma, something about lasers, the miracle of propranolol, or the genetic mutation of CLOVE Syndrome (I jest on the last, as a hot tip for the Limerick exam in 2015, but at least I now know about it).

At the first “flick through”, the colour illustrations on every page are just what you would expect from this publisher and for what is naturally a very photogenic topic. By page 6 you already have five classifications or staging systems for vascular anomalies and a good discussion as to why there is such debate. I liked the simpler method proposed here, those you are born with and those that come later! 

As I read about fast flow or high flow lesions, I realised how little I knew beyond recognising  a red lump as a topic for this book. Table 3.2 fills page 16 and yet makes for easy reading, but shows how relevant can be the distinction between the two.

Pathology, radiology, surgery of true haemangiomas and vascular malformations (by now you will know the difference) each merit their own chapters. MRI scans abound; I found few CTs, largely of ethmoids or necks (with carotid body tumours). I never did know that the bowed posterior wall of the maxillary sinus in juvenile angiofibroma was the Hollman-Miller sign! Throughout, the text is as good as the quality of illustration, whether lesions, imaging or surgery  (usually one of the two suffers, I feel, as a reviewer). I did note Fig 12.12 using a laser fibre for a supraglottic lesion, immediately adjacent to a plastic endotracheal tube, which seemed sporting.  (I do accept it was not a COlaser, however….)

The final two chapters are of relevance outside ENT paediatric practice, covering tumours such as paragangliomas, angiofibromas and Kaposi ’s sarcoma.  It may be stretching the definition of vascular tumours to include (what is a very good and welcome) coverage of meningioma, olfactory neuroblastoma and melanoma. Granted, they can prove highly vascular, even if that is not their origin.

This has cleverly identified an important topic, which can be explored in depth. It is well updated and I found it very easy reading. After 12 years as an examiner, I have served my time, but, had I had this book years ago, that viva across the table could have been far more challenging. It is remarkably cheap, for its content and far better value than an exam resit!

Amazon Link: Vascular Lesions of the Head and Neck
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