INTRAORAL HEMANGIOMA PDF

Hemangiomas are benign neoplasms that are common in the head and neck, but relatively rare in the oral cavity. They can cause esthetic and functional impairment, depending on location. The most common site is the upper lip, but they can occur in other areas, such as the tongue, buccal mucosa and palate. Treatment is primarily dependent on correct diagnosis of the lesion and on its anatomic location.

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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. Hemangioma is a vascular neoplasm or a vascular anomaly due to proliferation of blood vessels. They occur anywhere in the body, but skin and oral mucosa in the region of the lips, tongue, and buccal mucosa are most commonly affected. Therefore, the dentist or oral surgeon should be informed about their clinical aspect, diagnosis, and therapy [ 1 — 3 ].

The clinical aspect of oral hemangiomas depends on their location and depth. The size of hemangiomas is variable, ranging from a few millimeters to several centimeters in the form of a macule, papule, nodule, or tumor, with elastic or fibrous consistency [ 8 ]. In order to obtain a definite diagnosis of vascular malformations of suspected hemangioma , different clinical examination methods can be implemented, including digital compression and diascopy [ 6 , 7 ] and other supplementary imaging tests such as ultrasonography with Doppler and MRI [ 9 , 10 ].

Various modalities have been used in the treatment of hemangiomas, depending on their location, size and depth, evolution of injury, and involvement of adjacent structures [ 8 , 10 ]. The gold standard for hemangioma treatment, especially for smaller circumscribed lesions and peripheral hemangiomas, is conventional surgical excision [ 3 , 11 ]. However, complications that arise from conventional invasive surgical procedures such as excessive postoperative bleeding compelled the use of other different therapeutic alternatives including systemic corticosteroids, laser therapy, cauterization, cryotherapy, radiotherapy, and sclerotherapy [ 4 , 12 — 14 ].

These modes of treatment can be applied individually or in concert. The Objective. According to patient's complaint, she had noticed an asymptomatic blue-colored lesion on the right side of the cheek about six months ago. Intraoral physical examination revealed an indolent, well defined purple colored lesion under intact mucosa of the cheek, soft on palpation with dimensions around 1. Based on medical history and clinical examination, the lesion was diagnosed as submucosal hemangioma of the cheek.

Slow injection of 1—1. After injecting the agent, local hemostasis was performed by digital compression at the site of injection. The effect of therapy was evaluated on the following visits. During the following third visit Figure 5 , around two weeks later, intraoral examination revealed complete disappearance of the lesion, so the sclerosant therapy was terminated and the patient was appointed for the next visit after one month. After almost two months, by a phone call, the patient notified us that the lesion had completely disappeared without any sign of recurrence.

There are many treatment modalities reported in the literature for oral hemangiomas, such as intralesional and systemic corticosteroid treatment, surgical excision, thermocauterization, laser photocoagulation, and sclerotherapy [ 4 , 12 — 14 ]. Each of the treatment modalities has its own risks and advantages. Advantages of sclerotherapy to other hemangioma treatment modalities include it being very simple and safe to apply, affordable, and readily available, with most of this being due to not requiring special equipment for application and having no need for hospitalization of the patient.

Most importantly, it has shown high efficacy, offering partial or complete regression of the lesion without bleeding [ 4 , 15 — 18 ]. Disadvantages of sclerotherapy include postoperative pain and burning sensation, potential anaphylactic reaction, tissue necrosis, and airway compromise [ 19 ]. Currently, sclerotherapy is largely employed because of its effectiveness and ability to conserve the surrounding tissues [ 20 ].

Sclerotherapy has been proven effective in the treatment of benign vascular lesions, especially small lesions located on sites with esthetic impact, where surgery could leave unpleasant scarring [ 4 , 15 , 16 , 21 , 22 ]. Polidocanol aethoxysklerol and sodium tetradecyl sulfate STS are the best known detergent solutions which act by causing localized inflammatory reaction, obliterative thrombosis of hemangiomatous space, and subsequent fibrosis of the endothelial spaces, leading to the regression of the lesion [ 25 — 27 ].

These advantages of sclerosant use are the absence of pain on intravascular injection, a high level of efficacy and safety, and a very low occurrence rate of allergic reactions [ 28 ]. The quantity of injected sclerosing agents and the number of applications during the sclerotherapy treatment depend on the size and location of the lesion and involvement of adjacent structures, not forgetting to mention the obtained results, which should be evaluated before the administration of the next dose after an interval of 1 to 2 weeks [ 4 , 14 , 15 , 26 ].

The results of sclerotherapy were followed and assessed after a certain time period ten days—two weeks from the sclerotherapy session. The case has proven that intralesional injection of the aethoxysklerol 0.

The results of the actual study were similar to the data of literature relating to sclerotherapy, with variations according to the type of sclerosing agent, its concentration, the number of injections, and the intervals between each treatment session [ 13 , 14 , 18 , 24 , 29 , 30 ]. Winter et al. Another treatment option of oral hemangioma treatment is laser therapy based on the coagulative effect of superpulsed laser beams, leading to a virtually painless vaporization of tissue [ 31 ].

Lasers have indications for use in dentistry for incision, excision, and coagulation of intraoral soft tissue. They are well suited for surgical removal of intraoral hemangiomas because they offer a bloodless operational technique and avoid tissue damage. Advantages of laser therapy include minimal postoperative pain, minimally invasive surgery, and no need for sutures with no intraoperative or postoperative adverse effects [ 32 , 33 ]. Laser treatment is currently used for thin, superficial lesions, ulcerated hemangiomas, and residual erythema and telangiectasias.

The effective depth of penetration of PDL is minimal to a depth of around 1. Nd:YAG laser is used for treating the deep component of hemangiomas of the oral cavity and requires very careful use by experienced physicians.

KTP lasers are also an option, especially for deeper, thicker lesions. When the KTP laser is used with an intralesional bare fiber, the laser light is sent directly into the deep component of the hemangioma, delivering the maximum amount of laser energy to this section while limiting cutaneous damage [ 35 ].

Currently, there are no optimal laser systems for hemangioma treatment [ 37 ]. Crisan et al. Therefore, laser and cryotherapy are not commonly used in treatment of haemangiomas due to scarring or hyperpigmentation, skin atrophy, and slight depression of the skin and due to high cost [ 39 , 40 ].

The surgical treatment of oral hemangiomas, similar to other treatment modalities, has its own risks and advantages. The advantage of the surgical treatment is that, unlike other forms of hemangioma treatment, it allows for a microscopic diagnosis. In addition, the complete surgical excision of these lesions offers the best chance of cure, but it is often accompanied with the risk of excessive postoperative bleeding and severe functional impairment of vital functions, such as swallowing, speech, and airway maintenance.

Therefore, surgical intervention as a treatment modality for haemangioma is considered a last resort due to intraoperative bleeding, postoperative scarring, incomplete excision, recurrence, functional impairment, and surgical morbidity [ 15 , 41 ]. Since sclerotherapy is a very effective, inexpensive, and easy-to-apply treatment modality, it should be regarded as the primary choice of treatment, especially for intraoral superficial hemangiomas. National Center for Biotechnology Information , U.

Journal List Case Rep Dent v. Case Rep Dent. Published online Nov Author information Article notes Copyright and License information Disclaimer.

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Hemangioma is the clinical term for a benign vascular neoplasm due to proliferation of the endothelial lining of blood vessels.

Introduction Hemangioma is a vascular neoplasm or a vascular anomaly due to proliferation of blood vessels. Open in a separate window. Figure 1. Submucosal hemangioma of the cheek at the right molar region. Figure 2. Figure 3.

Second appointment after twelve days: regression of hemangioma. Figure 4. Figure 5. Third following visit: hemangioma disappeared without complications. Discussion There are many treatment modalities reported in the literature for oral hemangiomas, such as intralesional and systemic corticosteroid treatment, surgical excision, thermocauterization, laser photocoagulation, and sclerotherapy [ 4 , 12 — 14 ].

Conclusion Since sclerotherapy is a very effective, inexpensive, and easy-to-apply treatment modality, it should be regarded as the primary choice of treatment, especially for intraoral superficial hemangiomas. Competing Interests The authors declare that they have no competing interests. References 1. Prevalence of oral hemangioma, vascular malformation and varix in a Brazilian population. Brazilian Oral Research. Sclerotherapy for venous malformations. Journal of Pediatric Surgery.

Cardoso C. Surgical approach of intraoral hemangioma. Rodrigues Johann A. Sclerotherapy of benign oral vascular lesion with ethanolamine oleate: an open clinical trial with 30 lesions. Gomes D. Mucosal varicosities: case report treated with monoethanolamine oleate. Toledo H. Prado B. Neville B. Rio de Janeiro, Brazil: Elsevier; Patologia epitelial; pp.

Yoshida H. Use of doppler color flow imaging for differential diagnosis of vascular malformations. A preliminary report.

Journal of Oral and Maxillofacial Surgery. Redondo P. Vascular malformations II. Diagnosis, pathology and treatment.

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Oral Haemangioma

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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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Sclerotherapy of Intraoral Superficial Hemangioma

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