Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Retrospective data analysis of referral letters for orofacial vascular anomalies to a tertiary center

  • Received : 2024.07.29
  • Accepted : 2024.12.03
  • Published : 2024.12.20
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Vascular anomalies are disorders of the vascular system. These anomalies are classified as either vascular tumors or vascular malformations, with each possessing distinct characteristics. This study was performed to analyze vascular anomaly referrals to a tertiary center, identify patterns of misdiagnosis, and create a proforma to ensure the comprehensiveness of clinical information. Methods: We retrospectively analyzed vascular anomaly referral letters received by Hospital Tunku Azizah from 2018 to 2023. Specifically, we descriptively analyzed the inclusion of vascular anomaly characteristics, the demographic profiles of referrers and patients, and basic clinical findings. Subsequently, we developed a redesigned proforma. Results: Overall, 47 referral letters were analyzed. The patients comprised 25 boys and 22 girls, with ages ranging from birth to 14 years. Patient name, sex, and date of birth, along with the referrer’s name and address, were satisfactorily documented. The review revealed that 44 (93.6%) of the letters included the patient’s presenting problem, 43 (91.5%) contained clinical findings, 37 (78.7%) reported diagnostic investigations, and 29 (61%) referenced medical history. Regarding characteristics of vascular conditions, over half of the letters detailed time of appearance (n= 40, 85%), growth (n= 24, 66%), complications (n= 25, 53.2%), color (n= 32, 68%), and shape (n= 34, 72%). However, fewer than half mentioned compressibility (n= 7, 14.8%), pulsation (n= 7, 14.7%), and associated conditions (n= 2, 4.3%), and none referenced involution. Conclusion: Although demographic data were generally well-documented, critical medical history information was frequently omitted, including a lack of adequate pre-referral investigations. Key characteristics of vascular anomalies, namely compressibility, pulsation, associated conditions, and involution, were frequently overlooked. Accurate documentation of these features is crucial for determining treatment urgency. A standardized proforma must be implemented to ensure that vital information is captured, thus facilitating diagnosis and optimizing patient care.

Keywords

Acknowledgement

We extend our gratitude to the Director General of Health Malaysia for granting permission to publish this article, to Mr. Shahrul Aiman from the Clinical Research Center, Hospital Sultanah Bahiyah, and to Mr. Chua Kin Wei from the Clinical Research Center, Hospital Taiping, for their guidance on statistical analysis.

References

  1. Mulliken JB, Glowacki J. Hemangiomas and vascular malfor-mationsin infants and children: a classification based on endo-thelial characteristics. Plast Reconstr Surg1982;69:412-20. https://doi.org/10.1097/00006534-198203000-00002
  2. Levin DE, Speer AL, Pierce JR, Nowicki D, Arkader A, Stanley P, et al. Room for improvement: patterns of referral misdiagnosis to a vascular anomalies center. Open J Pediatr 2013;3:331-6. https://doi.org/10.4236/ojped.2013.34059
  3. Sepulveda A, Buchanan EP. Vascular tumors. Semin Plast Surg 2014;28:49-57. https://doi.org/10.1055/s-0034-1376260
  4. Kim TH, Choi JW, Jeong WS. Current concepts of vascular anomalies. Arch Craniofac Surg 2023;24:145-58. https://doi.org/10.7181/acfs.2023.00332
  5. Lee EY, Ang YS, Kuick CH, Mok Y, Chang KT, Toh LH, et al. Identifying genetic mutations in vascular anomalies using a sequencing panel for childhood cancers: a pilot study. J Vasc Anom 2024;5:e094.
  6. Sadick M, Muller-Wille R, Wildgruber M, Wohlgemuth WA. Vascular anomalies (part I): classification and diagnostics of vascular anomalies. Rofo 2018;190:825-35. https://doi.org/10.1055/a-0620-8925
  7. Jackson IT, Carreno R, Potparic Z, Hussain K. Hemangiomas, vascular malformations, and lymphovenous malformations: classification and methods of treatment. Plast Reconstr Surg 1993;91:1216-30. https://doi.org/10.1097/00006534-199306000-00006
  8. Monroe EJ. Brief description of ISSVA classification for radiologists. Tech Vasc Interv Radiol 2019;22:100628.
  9. Moloney J, Stassen LF. An audit of the quality of referral letters received by the Department of Oral and Maxillofacial Surgery, Dublin Dental School and Hospital. J Ir Dent Assoc 2010;56: 221-3.
  10. NHS England. Guide for commissioning oral surgery and oral medicine [Internet]. NHS England; c2015 [cited 2024 Jul 1]. Available from: https://www.dental-referrals.org/wp-content/uploads/2015/10/guid-comms-oral.pdf 10/guid-comms-oral.pdf
  11. Patel A, Stagnell S, Eaton K. The appropriateness of oral surgery referrals and treatment in contracted intermediate minor oral surgery practices in East Kent. Br Dent J 2019;227:211-6. https://doi.org/10.1038/s41415-019-0574-2
  12. Shaffie N, Cheng L. Improving the quality of oral surgery referrals. Br Dent J 2012;213:411-3. https://doi.org/10.1038/sj.bdj.2012.929
  13. Patel M, Khan AQ, Thiruchelvam J. Importance of quality in referral letters sent for potentially malignant oral, head and neck lesions. Dent Update 2011;38:192-8. https://doi.org/10.12968/denu.2011.38.3.192
  14. National Institute for Health and Care Excellence. Suspected cancer: recognition and referral [Internet]. National Institute for Health and Care Excellence; c2023 [cited 2024 Jul 1]. Available from: https://www.nice.org.uk/guidance/ng12
  15. Metcalfe C, Dailey Y, Lowe D, Rogers SN. Introduction of a referral pathway guide for general dental practitioners in Cheshire & Merseyside: the effect on two-week suspected cancer referrals. Br Dent J 2019;227:1058-62. https://doi.org/10.1038/s41415-019-1003-2
  16. Kourkouta S, Darbar UR. An audit of the quality and content of periodontal referrals and the effect of implementing referral criteria. Prim Dent Care 2006;13:99-106. https://doi.org/10.1308/135576106777795590
  17. Mahady K, Thust S, Berkeley R, Stuart S, Barnacle A, Robertson F, et al. Vascular anomalies of the head and neck in children. Quant Imaging Med Surg 2015;5:886-97.
  18. Greene AK. Vascular anomalies: current overview of the field. Clin Plast Surg 2011;38:1-5. https://doi.org/10.1016/j.cps.2010.08.004
  19. Scorletti F, Hammill A, Patel M, Ricci K, Dasgupta R. Malignant tumors misdiagnosed as benign vascular anomalies. Pediatr Blood Cancer 2018;65:e27051.
  20. Ng FY, Tang MM, Begum S, Leong KF. Vascular anomalies: a 3-year review in the Paediatric Institute Hospital Kuala Lumpur between 2013 and 2015. Malays J Dermatol 2017:22-30.
  21. Chamli A, Aggarwal P, Jamil RT, Litaiem N. Hemangioma. In: StatPearls [Internet]. StatPearls Publishing; 2023. Available from: https://pubmed.ncbi.nlm.nih.gov/30855820/
  22. Greene AK, Liu AS, Mulliken JB, Chalache K, Fishman SJ. Vascular anomalies in 5,621 patients: guidelines for referral. J Pediatr Surg 2011;46:1784-9. https://doi.org/10.1016/j.jpedsurg.2011.05.006
  23. Gong AJ, Khalil A, Weiss CR. Clinical emergence of low-flow vascular malformations after vaccination against SARS-CoV-2: a case series. J Vasc Anom 2022;3:e049.
  24. Davila-Villa P, Padilla-Rosas M, Meza-Garcia G, Nava-Villalba M. Vascular malformation of tongue with phlebothrombosis/phlebolith in a young patient: an unusual presentation. BMJ Case Rep 2022;15:e245850.
  25. Samadi K, Salazar GM. Role of imaging in the diagnosis of vascular malformations vascular malformations. Cardiovasc Diagn Ther 2019;9(Suppl 1):S143-51. https://doi.org/10.21037/cdt.2018.08.06
  26. Figueredo CA, Le LH, Nguyen KC, La TG, Lou EH, Kaipatur NR, et al. Ultrasound imaging of the periodontium complex: a reliability study. Int J Dent 2023;2023:5494429.
  27. Brahmbhatt AN, Skalski KA, Bhatt AA. Vascular lesions of the head and neck: an update on classification and imaging review. Insights Imaging 2020;11:19.
  28. Lo K, Mihm M, Fay A. Current theories on the pathogenesis of infantile hemangioma. Semin Ophthalmol 2009;24:172-7. https://doi.org/10.1080/08820530902805438
  29. Behr GG, Johnson C. Vascular anomalies: hemangiomas and beyond: part 1, fast-flow lesions. AJR Am J Roentgenol 2013;200:414-22. https://doi.org/10.2214/AJR.11.7852
  30. Steiner JE, Drolet BA. Classification of vascular anomalies: an update. Semin Intervent Radiol 2017;34:225-32. https://doi.org/10.1055/s-0037-1604295
  31. The Royal Children's Hospital Melbourne. Venous malformation and glomuvenous malformation [Internet]. The Royal Children's Hospital Melbourne; c2024 [cited 2024 Jul 1]. Available from: https://www.rch.org.au/plastic/department_sections/Venous_malformation_and_glomuvenous_malformation/
  32. Vascular Birthmarks Foundation. Venous malformation [Internet]. Vascular Birthmarks Foundation; c2024 [cited 2024 Jul1]. Available from: https://birthmark.org/birthmark/venousmalformations/
  33. Lee JW, Chung HY. Vascular anomalies of the head and neck: current overview. Arch Craniofac Surg 2018;19:243-7. https://doi.org/10.7181/acfs.2018.02383
  34. Zwicker K, Powell J, Cummings C. Vascular anomalies in childhood: when to treat and when to refer. Paediatr Child Health 2022;27:310-4. https://doi.org/10.1093/pch/pxac057
  35. Nozaki T, Nosaka S, Miyazaki O, Makidono A, Yamamoto A, Niwa T, et al. Syndromes associated with vascular tumors and malformations: a pictorial review. Radiographics 2013;33:175-95. https://doi.org/10.1148/rg.331125052
  36. Martinez-Lopez A, Salvador-Rodriguez L, Montero-Vilchez T, Molina-Leyva A, Tercedor-Sanchez J, Arias-Santiago S. Vascular malformations syndromes: an update. Curr Opin Pediatr 2019;31:747-53. https://doi.org/10.1097/MOP.0000000000000812