Lateral views of a variety of ear hemangiomas causing ear deformity.
Hemangiomas are the most common benign tumor of infancy, and they can occur anywhere on the body, including on and around the external ear and the salivary gland in front of the ear (parotid gland). Ear hemangiomas often distort the shape of the ear, and can result in permanent external ear deformities. Parotid hemangiomas are one type of hemangioma affecting the ear that can compress the external ear canal and stretch the skin of the cheek in front of the ear.
Infantile hemangiomas are the most common type of hemangioma, and usually appear within the first few weeks of life. They generally grow during the first year of life, and then slowly shrink over the next several years.
Some types of hemangiomas are present at birth. In some cases, these may shrink (or involute) rapidly within the first year of life (rapidly involuting congenital hemangioma, also called RICH), while others do not shrink (noninvoluting congenital hemangioma, or NICH).
During the growth period, some patients with ear hemangiomas may be candidates for laser therapy if the hemangioma is relatively small and flat. Because the laser penetrates only about a millimeter into the skin, thicker and deeper hemangiomas are less responsive to laser treatments.
Topical or oral beta blockers, such as Timolol gel and Propranolol, have largely replaced steroid therapy to stop the growth of hemangiomas. If your child has an ear hemangioma and or facial hemangioma, she may be referred to CHOP’s Dermatology Section to determine if oral beta blocker therapy is the best treatment approach. Patients undergoing beta blocker therapy may be admitted to the hospital during the first several days of treatment so the medical team can monitor for potential side effects, including low heart rate, low blood pressure and low blood sugar.
In cases where ear hemangiomas do not respond well to medical treatment, or if your child is left with residual ear deformities after initial treatment, surgical treatment may be necessary. Surgery for ear hemangiomas involves the removal (excision) of extra skin and fatty scar tissue, and in some cases, surgical reconstruction of the ear.
Any left over red or purple pigmentation (coloring) can be treated with laser therapy.
Lateral view of large ear hemangioma in infancy (left), after surgical debulking (middle), and after ear piercing as teenager.
CHOP provides multidisciplinary treatment for vascular anomalies such as ear hemangiomas. Specialists from plastic surgery, dermatology, interventional radiology, ophthalmology and neurology meet monthly to review complicated cases and ensure your child is receiving the best possible coordinated care. CHOP’s Division of Plastic Surgery also has a dedicated Vascular Anomalies Program where children have access to a team of experts who specialize in treating vascular anomalies.