Treatment of involuting or involuted hemangiomas causing facial asymmetry: A tailored algorithm based on magnetic resonance imaging findings

Large unilateral facial hemangiomas, particularly those involving the parotid gland, are significant due to their potential to cause severe facial asymmetry. No universally accepted classification exists for assessing the severity or determining appropriate surgical interventions. This study proposes an algorithm for managing involuting or involuted hemangiomas with facial asymmetry, based on magnetic resonance imaging (MRI) findings. Sixteen patients presenting with facial asymmetry who underwent surgical procedures for involuting or involuted hemangiomas were included in this study. Patients were categorized into four types based on the association between MRI findings of hemangiomas and surgical procedures. Those without facial asymmetry who did not require surgery were classified as Type I and were therefore excluded from analysis. Ten patients who received liposuction were classified as Type II, three patients who underwent lipectomy with a minimal access cranial suspension lift were classified as Type III, and three patients who underwent lipectomy with formal facial nerve dissection were classified as Type IV. All 16 patients showed improvement in facial asymmetry and deformity. The mean postoperative follow-up period was 7.8 months. No major complications were observed in any of the types. Surgical interventions of hemangiomas associated with facial asymmetry are typically performed during the involuting or involuted phase, offering a less invasive approach with lower morbidity. Preoperative MRI findings can effectively delineate the extent and depth of fibrofatty tissue, assisting surgeons in selecting the optimal therapeutic strategy. Our classification system may serve as a practical guide for surgical planning.