Sibgutulah Rashid, Rudra Deo Kumar, Somansh Goyal, Shivendra Choudhary
Current comparative evidence is limited and heterogeneous, precluding recommendation of any single sclerosant as superior. Treatment should be individualized, and well-designed randomized controlled trials are needed to establish comparative efficacy and safety.
OBJECTIVE: To compare the efficacy and safety of different sclerosing agents used in the management of oral and maxillofacial venous malformations through a systematic review and meta-analysis.
STUDY DESIGN: A comprehensive search of electronic databases and clinical trial registries was conducted from inception to July 2025 following PRISMA guidelines. Comparative randomized and non-randomized studies evaluating two sclerosants with a minimum follow-up of 2 months were included. Risk of bias was assessed using RoB 2 and ROBINS-I, and certainty of evidence was evaluated using GRADE. Meta-analysis was performed where appropriate.
RESULTS: Six comparative studies involving 425 patients were included. Bleomycin, sodium tetradecyl sulfate (STS), pingyangmycin, polidocanol, ethanol, and sodium morrhuate were evaluated. Bleomycin demonstrated higher response rates and a more favorable safety profile than STS; however, pooled analysis of three studies (n = 120) showed a non-significant trend favoring bleomycin (OR, 2.88; 95% CI: 0.51-16.19) with very low-certainty evidence. Polidocanol and pingyangmycin showed promising efficacy in limited studies, whereas ethanol was associated with higher complication rates.
CONCLUSIONS: Current comparative evidence is limited and heterogeneous, precluding recommendation of any single sclerosant as superior. Treatment should be individualized, and well-designed randomized controlled trials are needed to establish comparative efficacy and safety.