Management of oral hemangioma Review

of the




of a case


emangiomas arc- dcvclopmcntal vascular almormalities, mow than 50 par writ of which owur in the heat1 ant1 neck region.‘, ‘; They owur in the oral cavity at any age, without sexual or racial predisposition. These lesions are clasSifid by manp authors as hamartomatous in nature. IIistologically, a prdiferation of endothelial cells with the formation OS vascular channels is characteristie.” L’ The appcaranw on the oral muwsa may Iw as single or multiple areas, OT as one cdensi\c area involving dcqxr wnnwtivc tissue ant1 muwlr.” The multicentric type tcntls to increase in size ant1 to form onv large mass. The possibility of malignant transformation is evitlcncccl I)\- the iicniangioperi~;vtonlas and hcrnnngiocndothclion~as which arc ocwsionally seen in infants.’ Tndications for imrncvliato tlcfinitire troatmcnt arc in\-ol\cmcnt of vital struvturw, rapid growth with cosmetic tlcstruction, mcv~hanic~al or physical tlestruction, hemorrhage, and thrcatcned cardiovascular physical clecompensatioii.’ Tn atltlition, such factors as thr age of the paticwt, the size of the lesion, and the proximity of vital structures i11'1' paramount in the tlctwmination of thcraptutic approa(‘h.



I Iemangiomas have hoc11 watlicatccl by various means, among which the following have i)ccn clinically suwcssful : conscientious observation, USCof radiation, stwoitls, cmholization, itlltirllctal~olitt~s, sclcrosing solut,ioiis, surgical operation, or 2 coml~iilation of sclcrosing agents and surgical operation. ln cdhil(lrcn, conscientious ohscrwtion of hcmangiomas is warranted bccausc of


Fig. .S. Mid-pxlatal



J. Tnjwtion nf sodium morrhuatc: :It swontl visit.

extc,nsion of Icsion.

into hemangiomatous


in nmxilk~ry


01:tl SUITS .J uly,




‘1’11~patient’s past mrdical history was essentially unremarkable, and the findings of all laboratory studies wwe within normal limits. On June 4, 1975, ljilateral infraorbital and :lw twior palatine blocks were effected with a local anesthetic. After aspiration, 0.2 C.C. of sodium morrhuate was injected via tuberculin syringe into the anterior palate betlveen the maxillar) and uvular portions of the lesion. IVhen the patient returned one week after the first injection, an additional I.2 c.r. OI sodium morrhuatc was injected, again aftw local anesthesia had been cffectcd, and a portiwj of thv solution was now injected into the maxillary-ridge aspect of the lesion (Fig. 3 ). Fig. i ~lemonstrates the moderatv tlegrcc of ulceration that oeeurrrd sulwquent to the, first writ of injwtions. The patient returned on June 17, 1975, for the operation. The maxillary rillg(, appeared to he moderately ulcerated and somewhat fibrotic. Vascularity XIS markedly dimiw ished from the midpalate to thv area of the redundant tissue.


This case tlcmonstrates scvtwl considerations in thv management of intraoral littmatlgiomas. As notctl carlicr, many avenws of manapcment exist. A comhinatioll approach with sclerosing solution anal operation was clectcd in this instance, for wwral was011s. First, the patient rcfuwd any tvpt’ of cxtensiw operation. Scconcl, the lesion had been prcwnt~ for at least 20 years. At no time did the patirnt cspericnce clifficulty of any Bind, including hemorrhage. Finally, this partie-

F%g. 5. Higkpower

view of histopathologie


lesion, because of its anatomic presentation, was amenable to the approach nsccl : by sclerosing a communicating segment in the midpalate, the body of the lesion was effectively isolated from its peripheral extension on the maxilla. Hesection of the redundant tissue was thereby rendered a less hazardous procedure. Cryosurgery was considered as a possible means of treatment, but the proximity of palatal bone precluded this approach. The use of radiation, steroids, or antimetabolites was too severe for the procedure intended. Embolization would have been technically difficult and inappropriate. Sharp dissection with electrocautery was a viable alternative method that was not used hecausc of the possibility of uncontrollable hemorrhage. The USCof sclerosing solution alone would not have eliminated the fibrotic, redundant tissue which was the patient’s primary concern. Sclerosis and sharp dissection in combination afforded the least c&omplcx alld most, conservative approach to the problem. ular


Various treatment modalities in the management of hemangiomas have been rcGwec1. T’rcscntcd is a cast of liemangioma of unusual configuration ant1 its subsequent management. REFERENCES

1. (‘unningham, I). H., and Paletta, F. S.: Control of drtwiovenous Fistulac in X1ssiv-e Fackl Hemangioma hy Muscle Emboli, Plast. Keconstr. Surg. 46: 305.308, 1970. 2. TkLc~on, E. : Treatment of JTemangioma TVith Rclerosing Solution, Dent. Surwy 47: 29-.X$ 19il. 3. J)onrga~f, IV’. L., and Ridcntrour, C. E.: Trwtmrut of Carcw~ous Hemangioma of tlw Tongw by Contmuous Intra-arterial Infusion of S-Fluorouracil, Am. .T. Hurg. 114: 948-952, 1967. 4. J”riedlandrr, A. II., and Z(aft’, H.: Scltarosing Hemangioma of the ‘~ongm-Report of Caw, .l. Oral





5. E’riwlman , .J. M., Qormlry, M. I

Management of oral hemangioma. Review of the literature and report of a case.

Management of oral hemangioma Review of the literature and report of a case H emangiomas arc- dcvclopmcntal vascular almormalities, mow than 50...
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