HEMANGIOMA / oral surgery courses

HEMANGIOMA – A CASE
REPORT
INDIAN DENTAL ACADEMY
Leader in continuing Dental
Education
www.indiandentalacademy.com

Name : Mr. Vijayanand
Age/Sex : 20yrs/ male

CHIEF COMPLAINT
Swelling in the lower left side of face since birth.
HOPI
Swelling is present since birth which has increased in
size with his age. It initially was the of a marble, which
has gradually increased to the present size of an orange.

Patient underwent surgery for the same swelling twice. First at
the age of 2 months and second, at the age of 2 years.
But the swelling again increased in size.
He was advised to wait until his growth is completed.
Patient gives history of
discharge of blood, on accidental trauma to the swelling &
decreases in size of swelling on pressing which regains its
size within a minute

PAST MEDICAL HISTORY
No History Of Diabetes Mellitus,
Hypertension ,
Asthma ,
Bleeding disorder ,
Allergic to drugs
PAST DENTAL HISTORY
First dental visit.

PAST SURGICAL HISTORY
Underwent uneventful surgeries twice for the same swelling.
PERSONAL HISTORY
No habits of smoking / chewing tobacco / alcohol
consumption

FAMILY HISTORY
Single,
Only son,
Both parents are hale and healthy.
CLINICAL EXAMINATION
Patient is calm, conscious, coherent and co-operative.
He is moderately built and moderately nourished.

VITAL SIGNS -
Temperature
Pulse
Respiratory Rate
Blood Pressure
No signs of anaemia, cyanosis, and jaundice.
Clubbing and pedal edema - Not seen.
REVIEW OF SYSTEMS
On review of systems -- All systems were normal
Normal

EXTRAORAL EXAMINATION

INTRAORAL EXAMINATION
SOFT TISSUE
Labial mucosa:
Left half of the lower lip has a swelling that is continuous with that
of buccal mucosa.

Buccal mucosa:

PROVISIONAL DIAGNOSIS
HEMANGIOMA of left side cheek and lip.
DIFFERENTIAL DIAGNOSIS
A-V Malformation.

INVESTIGATION
CT- Carotid Angiogram
(volume scan of neck was
done with I.V. contrast)

IMPRESSION
1)Left buccinator space soft tissue lesion with a
calcific foci.
2)With contrast there are two small clusters of
peripherally enhancing vessels, with no
significant enhancement of mass lesion, no
prominent artery feeders seen. A few veins are
seen draining into left internal jugular vein and
anterior jugular vein.
findings suggests the possibility
of soft tissue hemangioma.

FINAL DIAGNOSIS
HEMANGIOMA of left side cheek and lip.

TREATMENT
Surgical Excision.
POST-OPERATIVE

Two Months Later

HEMANGIOMA
is a tumorlike malformation composed of seemingly
disorganized masses of endothelium-lined vessels that are
filled with blood and connected to the main vascular system.
Vascular malformations are subcategorized according to the
predominant anomalous channels as either low-flow
(capillary, venous, or lymphatic malformations), or fast-flow
(arteriovenous fistulas and arteriovenous malformations).
DISCUSSION

CLINICAL FEATURES
85% of childhood-onset
Spontaneously regress after puberty.
Reddish blue - closer to epithelium; deep blue - little deeper in the
connective tissue.
Raised and nodular
Blanch under pressure
Thrombi in angiomas may eventually calcify - radiographically evident.
ORAL MANIFESTATIONS
Flat or raised lesion of the mucosa, usually deep red or bluish red and
seldom well circumscribed.
Tongue, lip mucosa

RADIOLOGICAL FEATURES
Radiographically – intra osseous hemangioma – honeycombed
pattern.
HISTOLOGICAL FEATURES
Many small capillaries lined by a connective tissue stroma of
varying density.
INVESTIGATIONS
Angiography is considered most definitive of the studies.
Two of the most widely available methods in MR Angiography
are time of flight (TOF) and phase contrast (PC)
Contrast – enhanced MRI (hemangioma/ lymphangioma).

TREATMENT
Surgical excision and injecting sclerosing agents.
Hemangiomas respond to steroids in 30 to 60% of cases
(Subglottic hemangioma)
In pediatric patients with massive or life-threatening
hemangiomas, interferon alfa-2a therapy is an effective
treatment option.

CONCLUSION
The clinical presentation of vascular congenital abnormalities
range from, asymptomatic birthmark to life threatening
situation like congestive heart failure or exsanguinating
hemorrhage. Those afflicted will seek help from many
different physicians and undergo repetitive examination for
diagnosis, which frequently results in failed attempts of
treatment, leading to exacerbation of symptoms, lesion
recurrence, and disability.

Various sclerosing agents are proved ineffective in treating high-
flow lesions.
Ligation of external carotid artery also fails usually because of
many anastomoses, which promote the rapid appearance of a
collateral circulation.
Embolization combined with surgical treatment is still the most
common approach.

REFERENCES:
1. Noninvoluting Congenital Hemangioma: A Rare Cutaneous
Vascular Anomaly
Plast. Reconstr. Surg. 107: 1647, 2001.
2. Three-dimensional identification of hemangiomas and feeding
arteries in the head and neck region using combined phase-
contrast MR angiography and fast asymmetric spin-echo
sequences
Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2005;100:609-13
3. . An Update on the Treatment of Hemangiomas in Children
With Interferon Alfa-2a
Arch Otolaryngol Head Neck Surg.1999;125:21-27

4. Management of subglottic hemangioma
Current Opinion in Otolaryngology & Head and Neck
Surgery 2004,12:509–512
5. Management of mandibular vascular malformations with
sclerotherapy.
Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2006;102:99-103
6. Burket’s Text Book of Oral Medicine - Martin S.
Greenberg, Michael Glick
7. Differential Diagnosis of Oral And Maxillofacial Lesions -
Norman K. Wood , Paul W. Gauz
8. Shafer’s Text Book Of Oral Pathology - R Rajendran, B
Sivapadasundharam

Thank
You

HEMANGIOMA / oral surgery courses

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