|Year : 2016 | Volume
| Issue : 1 | Page : 53-55
Sclerotherapy for hemangioma of the labial mucosa
Srikanth H Srivathsa
Department of Oral Medicine and Radiology, Sri Hasanamba Dental College and Hospital, Vidyanagar, Hassan, Karnataka, India
|Date of Web Publication||4-Jan-2016|
Srikanth H Srivathsa
Department of Oral Medicine and Radiology, Sri Hasanamba Dental College and Hospital, Vidyanagar, Hassan - 573 202, Karnataka
Source of Support: None, Conflict of Interest: None
Hemangiomas are hamartomatous proliferations of vascular origin. The prevalence of these lesions is about 7% of all the benign tumors of the body. The clinical appearance of hemangiomas varies depending on the location of the vascular proliferation. Complications though rare, can occur such as ulceration, bleeding either due to trauma or spontaneously as well a pain, making treatment a necessity. Different treatment modalities have been proposed both for cutaneous and oral hemangiomas. These include the use of intralesional injection of sclerosing agents, corticosteroids, and anti-cancer drugs. Laser therapy, using CO2and neodymium-doped yttrium aluminum garnet, has also been utilized. Larger lesions are treated with embolization and surgical excision. A case of hemangioma of the upper lip and labial mucosa in a 9-year-old girl, treated with an intralesional sclerosing agent, is being reported.
Keywords: Hemangioma, sclerotherapy, sodium tetradecyl sulfate, vascular malformation
|How to cite this article:|
Srivathsa SH. Sclerotherapy for hemangioma of the labial mucosa. Indian J Paediatr Dermatol 2016;17:53-5
| Introduction|| |
Hemangiomas are hamartomatous proliferations of vascular origin. The prevalence is approximately 7% of all the benign tumors of the body. About 60% of hemangiomas occur in head and neck region and most of them are found in females with a ratio of 3:1. One study found that the prevalence of oral hemangiomas to be 8%. They are vascular tumors that enlarge by a rapid cellular proliferation. Heparin, an angiogenic factor is considered to have an important role in the growth as well as involution of hemangiomas.
| Case Report|| |
A 9-year-old girl visited for the evaluation of a swelling of her upper lip of 6 years duration [Figure 1]. History revealed that the lesion had started insidiously 6 years back that gradually increased in size over a few months and then remained static. There was no history of any trauma preceding the onset. The lesion did not interfere with speech or function and was completely asymptomatic. On examination, the upper lip on the left side showed diffuse swelling with obliteration of the nasolabial fold. The labial mucosa showed diffuse swelling, measuring around 2.5 cm 2 in size, extending from the labial frenum region up to mucosa till the first deciduous molar. The color of the swelling was deep purplish-blue and the surface was irregular and appeared to be lobulated. No visible pulsations were noted. The swelling was nontender, pulsatile, partly fluctuant, soft, and partly compressible [Figure 2]. Diascopy was positive. The regional teeth appeared of normal morphology. The history and clinical features were suggestive of a Hemangioma. Ultrasonographic examination confirmed the vascular origin of the lesion [Figure 3]. Based on the clinical and ultrasonographic features, it was decided to treat the lesion using the sclerosing agent, sodium tetradecyl sulfate.
Treatment consisted of the administration of 2 ml of 3% sodium tetradecyl sulfate (sclerosing agent) into the lesion. The sclerosing agent was administered once in 2 weeks. The patient had noticed symptoms of pain in the area of injection for a period of 3 days following the first injection of sclerosing agent administration. The symptom was managed with nonsteroidal anti-inflammatory drugs (tablet ibuprofen – 200 mg t.i.d). After the third injection, the lesion had subsided by around 80% [Figure 4]. The patient was scheduled for two more sittings of injections, but failed to report. A telephonic conversation with the patient's parents revealed that they were satisfied with the results and declined any further intervention.
|Figure 4: Reduction of the lesion following sclerotherapy (posttreatment)|
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| Discussion|| |
Most of the intraoral hemangiomas are located on the tongue. Among 22 hemangiomas found in an analysis of 154 benign oral vascular lesions,
seven lesions were found on the lip, with two on the upper lip, and five on the lower lip. The lesion in the present case was found on the upper lip and labial mucosa. The clinical appearance of hemangiomas varies depending on the location of the vascular proliferation. If the vascular proliferation is located close to the surface epithelium, then the color will be reddish blue if located deeper in the connective tissue, it will have a deep blue color. In the present case, the lesion had a purplish-blue hue, making it a superficially located lesion. Most of them measure 0.5–5 cm in size but larger lesions up to 20 cm may be found. Most hemangiomas are present at birth or appear shortly after and involute by the age of 10–15 years. In our case, the patient's parents had noticed the lesion 6 years back and that had remained still. Complications such as ulceration, bleeding due to trauma or spontaneously as well a pain can occur in hemangiomas., Our patient had not experienced any of these symptoms.
Diagnosis of intraoral hemangiomas is mainly clinical, based on the appearance, pulsatility as well as diascopy positivity. Further investigations such as ultrasound examination and color-Doppler examination, computed tomography scan, magnetic resonance imaging, angiography or scintigraphy can be used.,
A few clinicians recognize a separate clinical entity known as vascular malformation (VM). VM is considered to be of embryonic development, a defect in the structure of the blood vessel, whereas hemangiomas have a defect in the endothelium.
Different treatment modalities have been described for hemangiomas, both cutaneous and oral. These include the use of intralesional injection of sclerosing agents, corticosteroids, and anti-cancer drugs.,
Sclerosing agents are tissue irritants that injure the endothelium resulting in necrosis, fibrosis, and obliteration of the lesion., Various sclerosing agents, including sodium morrhuate, boiling water, nitrogen mustard, sodium tetradecyl sulfate, have been tried for the treatment of symptomatic hemangiomas and for embolization of high flow vascular malformation.
The mechanism of action of sclerosing agents is as follows. When injected into the vascular lesion, it results in endothelial injury, destruction and inflammation leading to fibrosis and eventual obliteration of the lesion.
Sodium tetradecyl sulfate, a long chain fatty acid with property similar to soaps is a synthetic surface acting substance, which is a clear, nonviscous liquid. Easy availability, effectiveness of action, and tolerance by the body with minimal side effects makes it the sclerosing agent of choice. Sodium tetradecyl sulfate is available in 1% and 3% concentration and 0.1–2 ml of the solution is injected in various directions of the lesion. Repeated injections are usually given at an interval of 21 days.
| Conclusion|| |
Oral vascular proliferations are uncommon on the labial mucosa. These lesions may be superficial or deeply located. Superficial lesions may show complications such as bleeding and pain, when injured. Recognition of these vascular lesions, as well as treatment, is important owing to the complications. One of the accepted and easiest modalities in treating hemangiomas includes injection of sclerosing solutions. Owing to the advantages of sclerosing agents over surgical procedures, it remains as one of the commonly advocated methods of the management of hemangiomas.
Declaration of Patient Consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]