Treatment of maxillary hemangioma with a sclerosing agent

Foam Polidocanol Sclerotherapy for Low-Flow Vascular Malformations of Tongue

INTRODUCTION

Low-flow vascular malformations (LFVMs) of the tongue are one of the most common presentations among different vascular anomalies of oral and maxillofacial regions. The present study was conducted with the objective to assess the outcome of a simple, easily available, safe and cost-effective therapeutic measure using foamed polidocanol in patients with LFVMs of the tongue.

MATERIALS AND METHODS

Fifteen patients with LFVMs of tongue were randomly selected in the study from the pool of 32 individuals affected with vascular malformation of oral and maxillofacial region. The diagnosis was made by a combination of clinical presentation and Doppler ultrasound. Lesions on the tongue were measured along their longer axis using a calliper and assigned to one of the three groups according to size: small-sized (<1 cm; 3 patients), medium-sized (between 1 and 3 cm; Four patients), or large-sized (>3 cm; eight patients). Foam sclerotherapy was done by directly injecting the foam (polidocanol) into identified sinusoids, under real-time ultrasound guidance. Foam polidocanol was prepared using the Tessari method.

RESULTS

Fifteen patients (Nine males and Six females), aged 7-50 years, with an average age of 23.53 years were included in our study. Of these 15 vascular lesions, three were small (<1 cm), four were medium (1-3 cm) and eight were large (>3 cm) in size. Treatment results were evaluated based on a reduction in lesion size. Complete or partial regression of lesions was reported by 14 (93.33%) patients and remained unchanged in one (6.67%) patient. The number of sclerotherapy sessions performed in this study ranged from 1 to 6 and was directly related to lesion size. Small- and medium-sized lesions responded well and complete resolution was seen in 1-3 sessions. Of the eight large lesions, seven showed complete or partial resolution in 4-6 sessions except one lesion which did not show any responses in subsequent sessions.

CONCLUSION

Foam polidocanol therapy for LFVM of tongue is cost-effective, less invasive and with added advantage of local anesthetic effect.

Benign oral vascular lesions treated by sclerotherapy with ethanolamine oleate: A retrospective study of 43 patients

Background

Although sclerotherapy is a common treatment for benign oral vascular lesions, there is no well-standardized protocol for this purpose. The aim of the present study was to describe the clinical characteristics of patients treated by sclerotherapy with ethanolamine oleate (EO), in order to contribute to a better understanding of this technique.

Material and Methods

Medical records and images of 90 patients treated by the same sclerotherapy protocol were retrieved and analysed. Thus, 43 cases with complete information were selected and described.

Results

The most affected age group was 41–70 years, with a female predominance and 86% of patients being Caucasian. Lips were the most affect site (70%) followed by the tongue (16%). Regarding clinical appearance, approximately 90% of lesions were classified as nodules, and 90% of patients reported no pain. Approximately 40% of lesions were 0.5–1.0 cm in size. In 58% of the patients, only one application of ethanolamine oleate was necessary. The application doses varied according to the lesion size and number of applications. Complete clinical regression occurred in 91% of cases, whereas 9% showed partial regression.

Conclusions

Sclerotherapy with EO is an acceptable, effective and affordable treatment for benign oral vascular lesions.

Key words:Hemangioma, vascular malformations, varicose veins, sclerotherapy.

Unusual intraosseous capillary hemangioma of the mandible

Intraosseous hemangioma is a benign vascular neoplasm, which is mostly seen in vertebrae, maxillofacial bones, and long bones. Intraosseous hemangioma is rarely seen on jaw bones compared to other skeletal bones and usually occurs in the cavernous form. Capillary intraosseous hemangioma of jaws is an uncommon form of intraosseous hemangioma and has not been thoroughly described so far. In this study, a case of capillary intraosseous hemangioma of the mandible was presented with relevant literature review.

Extragingival pyogenic granuloma histologically mimicking capillary hemangioma

Pyogenic granuloma is a tumor-like proliferation to a non-specific infection. The tumor-like growth is considered to be non-neoplastic in nature and presents in various clinical and histological forms in the oral cavity. Hemangiomas are benign vascular anomalies characterized by benign proliferation of blood vessels. The aim of this article is to drive attention toward the uncommon location of capillary hemangioma on the palate. In spite of their benign nature, intraoral capillary hemangiomas are always clinically important to be diagnosed well in time and suitably managed. The lesion in the present case although clinically diagnosed as pyogenic granuloma gave a histological picture of capillary hemangioma when surgically excised.

Oral capillary hemangioma: a clinical protocol of diagnosis and treatment in adults

PURPOSE

Hemangiomas are benign vascular anomalies characterized by benign proliferation of blood vessels. There are no well-defined criteria for the diagnosis and treatment of oral capillary hemangioma (OCH). The objective of this study is to report a safe, effective, and low-cost protocol for diagnosis and treatment of OCH.

MATERIALS AND METHODS

Eight patients were diagnosed with OCH, through two physical examination maneuvers-the diascopy and head lowering maneuver with abdominal compression (HLMAC). The treatment performed was sclerotherapy with ethanolamine oleate, weekly, until the disappearance of the lesion. No local anesthetics were administered prior to the sclerosing agent injection.

RESULTS

All cases showed a complete remission of the lesions after sclerotherapy. There were no visible scars or compromise esthetics or normal function, and there was no evidence of recurrence. Only one patient had superficial ulceration, which remained asymptomatic and healed without specific treatment.

CONCLUSIONS

This protocol was effective in the diagnosis of OCH through two physical examination maneuvers with low-cost and easy implementation, the diascopy and the HLMAC. The low concentration associated with a reduced amount of the sclerosing agent was responsible for the excellent results in the cases treated.

Management of haemangioma with sclerosing agent: a case report

The use of multiple weekly intralesional injections of 3% sodium tetradecyl sulfate as a sclerosing agent for the management of facial haemangiomas is a safe treatment with acceptable results. As presented in this case report, this technique offers the patient considerable relief of symptoms with minimal complications. However, the possibility of second-stage surgery to correct residual deformity is still considered. Sclerotherapy with 3% sodium tetradecyl sulfate provides a good preparation for further surgery.

Oral capillary haemangioma mimicking pyogenic granuloma: a challenge for diagnosis and management

Pyogenic granuloma (PG) is a localised granulation tissue overgrowth, in reaction to mild irritation. The aetiology of the lesion is not known, though it was originally believed to be a botryomycotic infection. The clinical diagnosis of such a lesion can be quite challenging. The purpose of this article is to report an unusual case of benign tumour in an adolescent boy who was clinically diagnosed as PG and histopathologically as capillary haemangioma. PG being a benign lesion; surgical excision was performed and predisposing irritants were removed.

Capillary hemangioma of palatal mucosa

Hemangiomas are common tumors characterized microscopically by proliferation of blood vessels. The congenital hemangioma is often present at birth and may become more apparent throughout life. They are probably developmental rather than neoplastic in origin. Despite their benign origin and behavior, hemangiomas in the oral cavity are always of clinical importance to the dental profession and require appropriate clinical management. This case report presents a case of capillary hemangioma of anterior palatal mucosa in a 13-year-old female.

Capillary hemangioma or pyogenic granuloma: A diagnostic dilemma

Pyogenic granulomas and hemangiomas of oral cavity are well-known benign lesions. Although pyogenic granuloma is known to show a striking predilection for the gingiva and capillary hemangioma for lips, check, and tongue, palatal occurrence of these lesions is extremely rare. The clinical diagnosis of such an uncommon occurrence can be quite challenging as they sometimes may mimic more serious lesions such as malignancies. The purpose of this article is to report an unusual case of benign tumor occurring on hard palate which was clinically diagnosed as pyogenic granuloma and histopathologically as capillary hemangioma.

Oral haemangioma

Vascular anomalies comprise a widely heterogeneous group of tumours and malformations. Haemangioma is the most common benign tumour of vascular origin of the head and neck region. The possible sites of occurrence in oral cavity are lips, tongue, buccal mucosa, and palate. Despite its benign origin and behaviour, it is always of clinical importance to the dental profession and requires appropriate management. This case study reports a rare case of capillary haemangioma on the palatal gingiva in a 14-year-old female.

Intraosseous hemangiomas

Intraosseous hemangiomas are classified as benign tumors of vascular nature. Some authors describe them as hamartomas. They originate and expand inside bone structures. They are usually congenital, rarely of posttraumatic origin. In the Maxillo-Facial Surgery departments of the Universities of Rome "La Sapienza" and "Tor Vergata," from 1990 to 2004, 11 cases of intraosseous hemangioma have been diagnosed. In 6 cases, the neoplasm localized in the zygomatic region; in 3 cases, at the mandible level; in 1 patient, in the maxillary site; and in 1 patient, in the frontal bone. Literature review and the case of a male patient affected by left orbitozygomatic hemangioma are described.

Intralesional laser treatment of voluminous vascular lesions in the oral cavity

OBJECTIVE

In laser treatment of voluminous vascular lesions, there are many cases in which submucosally located angioma remnants cannot be reached by noncontact superficial laser application. To diminish these remnants we used intralesional photocoagulation (ILP) in treatment of oral vascular lesions, because this approach is effective in treatment of voluminous vascular lesions of the skin.

STUDY DESIGN

Four cases of voluminous vascular malformation in the oral cavity were treated by ILP using a potassium-titanyl-phosphate (KTP) laser. In 1 case, treatment was carried out under ultrasound and manual control.

RESULTS

All lesions showed more than 70% regression after the first ILP session, and the treatment outcome was satisfactory. There were no serious complications, such as bleeding or invasive infection. Ultrasonography was useful for guiding laser treatment in the oral cavity.

CONCLUSION

Intralesional photocoagulation treatment with a KTP laser is effective and safe for treatment of a vascular lesion in the oral cavity.

Sclerotherapy of benign oral vascular lesion with ethanolamine oleate: An open clinical trial with 30 lesions

OBJECTIVE

The objective of this study was to report and discuss the results from treatment of benign oral vascular lesions with ethanolamine oleate.

STUDY DESIGN

Twenty-seven patients with 30 examples of oral vascular malformation, hemangioma, or varix were treated with intralesional injections of 1.25% or 2.5% ethanolamine oleate at an interval of 15 days between each application. The lesions were divided into 2 categories: (1) lesions of 20 mm or less and (2) those greater than 20 mm. Subsequently, the Mann-Whitney test was used a means of statistical analysis.

RESULTS

Although the number of injections varied from patient to patient, all lesions responded to the treatment, showing total clinical regression. Lesions of 20 mm or less needed a lesser number of applications than those greater than 20 mm (P < .05).

CONCLUSIONS

Ethanolamine oleate is a 100% effective sclerosant agent for treatment of benign oral vascular lesions. In this study, no difference was found between the 2 concentrations applied.

Intraosseous hemangioma of the zygoma

Zygomatic hemangioma is an extremely rare, benign, slow-growing tumor occurring mostly in adult women. The radiologic findings are diagnostic. Total excision of the tumor with primary reconstruction of the defect is the preferred treatment modality. We present a case of zygomatic hemangioma and a brief review of the literature.

Rare benign tumours of oral cavity--capillary haemangioma of palatal mucosa: a case report

Haemangiomas are benign tumours composed of blood vessels, they are probably developmental rather than neoplastic in origin. Haemangiomas are often present at birth but may become more apparent during life. The tumours appear as a flat or raised reddish-blue lesions and are generally solitary. They are occasionally seen on the palatal mucosa. Haemangiomas are classified on the basis of their histological appearance as capillary, mixed, cavernous or a sclerosing variety that tends to undergo fibrosis. Their differential clinical diagnosis is based on appearance. The tumours may be slowly progressive, involving extensive portions of the superficial and deep blood vessels. Function may be affected where development of the lesion is extra-invasive. Colour change on pressure is a common finding with return to the original colour on withdrawal of pressure. The case presented here was referred because of swelling and recurrent periodontal bleeding. The lesion was diagnosed as a capillary haemangioma through histopathology. Although different therapeutic procedures have been reported, in this case surgical excision was carried out under general anaesthesia following hospitalization. Despite their benign origins and behaviour, haemangiomas in the region of oral cavity are always of clinical importance to the dental profession and require appropriate clinical management. Dental practitioners and oral surgeons need to be aware of these lesions because they may pose serious bleeding risks.

Haemangioma of the Zygoma. Report of two cases with a review of the literature

Zygomatic haemangioma is a rare benign neoplasm occurring most frequently in adult females. The authors, after reviewing the available literature, report two cases which presented with a swelling of the zygoma. Resection of the neoplasm, immediate reconstruction with cranial bone grafts and internal rigid fixation was the treatment of choice. Results two years after surgery are presented.

Central arteriovenous malformations of the maxillofacial skeleton: case report

Central arteriovenous malformation of the maxillofacial skeleton, though rare, is a well-documented entity. Past treatments have usually included some form of surgical intervention. Surgical resection as an attempt to cure has been effective but costly, ie, in relationship to patient morbidity and hospital expenditures. A case of vascular malformation is presented in which selective angiography and embolization as a primary treatment were used rather than ablative surgery. The patient tolerated the procedures well, with complete resolution of bleeding.

Treatment of angiomas with sclerosing injection of hydroxypolyethoxydodecan

The authors discuss the indications for hydroxypolyethoxydodecan in the sclerosing treatment of angiomas, with particular reference to cavernous, venous, and evolutive angiomas (ie, immature angiomas that fail to involute by eight to ten months). Moreover, the sclerosing agent may be employed, in connection with embolization and subsequent surgery, in arteriovenous angiomas with a relevant cutaneous-subcutaneous development. The authors have successfully used the "interstitial" sclerosing technique, according to Andrews' method. This technique involves interstitial injections to obtain the sclerosis of the thin threads of fibrous tissue stroma between the blood vessels. The sclerosing therapy may cause the complete regression of "low flow" angiomas or, at least, a partial reduction that simplifies the ensuing surgical excision. In the case of partial regression of the angioma obtained with the sclerosing therapy, the surgery of the remaining angioma causes a lesser degree of bleeding (especially in areas that do not particularly lend themselves to surgical exploration, ie, the oral cavity); an increased reliability in the radicality of the intervention (due also to the reduced size of the lesion); and better results from an aesthetic-functional point of view.

Capillary hemangioma of the maxilla. A report of two cases in which angiography and embolization were used

This article presents two clinical cases of capillary hemangiomas of the maxilla. Such lesions are rare, as demonstrated by the review of the literature included in this article. The presentation, differential diagnosis, histopathology, management, and follow-up for each case are discussed. Our rationale for approaching these types of lesions, as well as our opinion that microembolization should be considered as a first line approach to treatment, is presented.

Central hemangioma of the jaws

Fifteen cases of central hemangioma of the jaws in 14 patients are reported, and considerations in diagnosis and treatment are discussed. In the management of these tumors, diagnostic considerations are of paramount importance if associated risks are to be minimized while maximizing the chances for a successful outcome. A search of the literature suggests that surgery, either alone or in combination with embolization, remains the treatment of choice for these lesions. All cases in this report were treated surgically without incident and with good results. Of special interest were two cases in which the tumor was removed from the excised mandible, which was then sterilized and used in the immediate reconstruction of the surgical defect.

Oral hemangioma treated with a sclerosing agent. Report of a case

A case of oral soft tissue hemangioma is reported. The treatment of the lesion with a sclerosing agent is described.

The treatment of facial haemangioma by percutaneous injections of sodium tetradecyl sulfate

Sotradecol--sodium tetradecyl sulfate--is a sclerosing agent which has been used for years in the treatment of varicose veins, haemorrhoids and haemangiomata. Two cases of large haemangioma of the cheek are presented. Because surgical treatment posed many difficulties we decided to treat with sodium tetradecyl sulfate. Treatment was successful.

Arterial embolisation in the treatment of central haemangiomas of the maxilla. Report of two cases

The recent refinement of super-selective angiography and subsequent embolisation offer new promising possibilities in the treatment of central haemangiomas in the maxillo-facial area, either as a pre-operative measure allowing safer surgical removal, or as definitive therapy. Two cases of central haemangiomas of the maxilla are presented, both treated successfully by embolisation.

Vascular anomalies of the maxillofacial region

A biologic classification based on clinical behavior and endothelial cell characteristics is used to divide vascular birthmarks into two groups: hemangiomas and vascular malformations. This system is applied to vascular anomalies of the maxillofacial region and is demonstrated with illustrative cases. The distinction between hemangioma and vascular malformation is important for maxillofacial surgeons because hemangiomas rarely affect bone, whereas malformations affect bone in 35% of cases.