Published23 Nov Abstract Hemangioma is the clinical term for a benign vascular neoplasm due to proliferation of the endothelial lining of blood vessels. Their most frequent location is the body skin and oral mucosa. One of the treatment modalities for hemangiomas is intralesional injection of sclerosing agents which cause the damage of blood vessels followed by their obliteration. The effect of sclerotherapy was evaluated on the following visits in time intervals of two weeks. The successful results of the study were comparable to the data of literature with variations according to the used sclerosant agent, its concentration, the number of injections, and the intervals between each session. Since sclerotherapy is a very effective, inexpensive, and easy-to-apply treatment, it should be the treatment of choice, especially for intraoral superficial hemangiomas.
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References Vascular anomalies are rare lesions, with head and neck being a common region for vascular malformations. Intra- oral occurrence of hemangiomas is very rare. These lesions are mainly classified into two groups, capillary and cavernous hemangiomas due to vascularization of the lesions. Capillary hemangiomas consist of small capillary vessels which show lobule formation, and cavernous hemangiomas consist of large dilated vessels and can reach to large sizes.
Many treatment modalities including sclerotherapy, embolisation, laser surgery and cryosurgery have been considered for hemangiomas. Case Report A 38 year old medically fit male reported to our dental outpatient department with the complaint of bleeding from the tongue occasionally since childhood.
History revealed that the lesion was comparatively bigger when he was a child with gradual reduction in size as the age progressed. Family history was not contributory. Patient was moderately built and nourished and vital signs were normal. On intra oral examination, a solitary, sessile, spherical shaped bluish-red swelling with distinct border and granular surface was noticed on the dorsal surface of the tongue in the anterior one third, measuring about 1cm x1cm anterio-posteriorly and superoinferiorly Figure A.
The swelling was soft in consistency, non tender, compressible and does not bleed on palpation. Chairside diascopy test was positive, which revealed blanching on pressure Figure B. A- Intra-oral hemangioma, on the anterior one third, dorsal aspect of the tongue. B- Diascopy test showing blanching of the lesion. Discussion Hemangiomas are well-known benign vasoformative tumors [1,2]. Occurance in the tongue is rare and tongue requires special consideration because of its susceptibility to minor trauma and consequent bleeding and ulceration, swallowing difficulties and breathing problem; although the major concern is cosmetic issues in many cases, though small intra-oral lesions are not of much aesthetic concern .
In the present case the lesion was noticed in the anterior one third of the tongue, which bled oftenly due to minor trauma. In , Mulliken and Glowacki described a classification scheme which is presently accepted. These vasoformative tumors are classified under 2 broad headings of hemangioma and vascular malformation. Hemangioma is further sub classified based on their histological appearance as: [6,7] 1 Capillary lesions 2 Cavernous lesions; and 3 Mixed lesions.
Hemangiomas are usually congenital, but some are acquired later in life [1,8]. In our case it is intramuscular. They occur as: [6,9] 1. Superficial, present as bright red to scarlet and dome shaped, which may partially blanch with pressure and are noncompressible on palpation; 2.
Deep, usually present as subcutaneous, partially compressible nodules with a bluish hue; 3. Hemangiomas are localized or diffuse errors of embryonic development and it has also been hypothesized that angiogenesis likely plays an important role in the vascular excess present in these lesion. Cytokines, such as growth factor, basic fibroblast and vascular endothelial growth factor are known to stimulate angiogenesis. Excesses of these angiogenic factors or decrease of angiogenesis inhibitors e.
Differential diagnosis that could be considered in our case is of a traumatic hematoma, mucocele, and angina bullosa haemorrhagica. However, contrast-enhanced MRI or angiography may be required to understand the depth of mass and to be informed about vascularization of large hemangiomas .
Ultrasound Doppler sonography also plays a major role in diagnosing the lesion. Histologically, hemangiomas are identified and characterized by endothelial cell proliferation . Concerning the treatment, most true hemangiomas require no intervention; they undergo spontaneous regression at an early age. Surgery, corticosteroids, sclerosing agents, radiation therapy, diathermy, electrocauterization, cryosurgery, embolization, laser, radiofrequency, and interferon are used in treatment of hemangiomas .
If superficial lesions are not an esthetic problem and not subject to masticatory trauma, they may be left untreated . Present case was left untreated, as the lesion was small and the patient was not willing for any treatment. The prognosis of hemangioma, in general, is excellent while recurrence and its ability to undergo malignant transformation is very rare following adequate treatment. Conclusion Although hemangiomas are common in the head and neck region, it is very rare in the oral cavity.
Though some hemangiomas involute with time, some do not. Various newer modalities in managing hemangiomas of the tongue are available; however surgery remains the mainstay treatment for most of the cases.
INTRAORAL HEMANGIOMA PDF
References Vascular anomalies are rare lesions, with head and neck being a common region for vascular malformations. Intra- oral occurrence of hemangiomas is very rare. These lesions are mainly classified into two groups, capillary and cavernous hemangiomas due to vascularization of the lesions. Capillary hemangiomas consist of small capillary vessels which show lobule formation, and cavernous hemangiomas consist of large dilated vessels and can reach to large sizes. Many treatment modalities including sclerotherapy, embolisation, laser surgery and cryosurgery have been considered for hemangiomas.
Sclerotherapy of Intraoral Superficial Hemangioma
Discussion The venous malformations are the commonest of all the vascular anomalies and have a propensity for the head and neck. They may be discrete or extensive. Sclerotherapy alone or in combination with surgical excision is now the accepted treatment modality in symptomatic venous malformations. Localized areas can be treated without an incision and diffuse, extensive lesions may be symptomatically palliated. Conservative management with numerous sclerosing agents boiling water, alcohol, sodium morrhuate, quinine, urethane, silver nitrate, iron, zinc chloride, liquid vegetable protein have been used since the 18 th century for the treatment of a wide variety of vascular anomalies.
Malataxe One-third to one-fourth of these lesions are painful and are usually associated with trauma. Subscribe to Table of Contents Alerts. Journal of Oral Laser Applications. Superficial arteriovenous hemangioma of the oral cavity. Acknowledgements The authors are grateful to Mr. Therefore, the dentist or oral surgeon should be informed about their clinical aspect, diagnosis, and therapy [ 1 — 3 ]. H and E stain section at 10x magnification showing numerous blood-filled capillaries in connective tissue stroma.