s
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
Home Print this page Email this page Small font size Default font size Increase font size Users Online: 2455

 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 17  |  Issue : 1  |  Page : 53-55

Sclerotherapy for hemangioma of the labial mucosa


Department of Oral Medicine and Radiology, Sri Hasanamba Dental College and Hospital, Vidyanagar, Hassan, Karnataka, India

Date of Web Publication4-Jan-2016

Correspondence Address:
Srikanth H Srivathsa
Department of Oral Medicine and Radiology, Sri Hasanamba Dental College and Hospital, Vidyanagar, Hassan - 573 202, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.172459

Rights and Permissions
  Abstract 

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

How to cite this URL:
Srivathsa SH. Sclerotherapy for hemangioma of the labial mucosa. Indian J Paediatr Dermatol [serial online] 2016 [cited 2020 Jul 9];17:53-5. Available from: http://www.ijpd.in/text.asp?2016/17/1/53/172459


  Introduction Top


Hemangiomas are hamartomatous proliferations of vascular origin. The prevalence is approximately 7% of all the benign tumors of the body.[1] About 60% of hemangiomas occur in head and neck region and most of them are found in females with a ratio of 3:1.[2] One study found that the prevalence of oral hemangiomas to be 8%.[3] 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.[4]


  Case Report Top


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.
Figure 1: Extra-oral photograph of the patient

Click here to view
Figure 2: Purplish-blue raised lesion on the labial mucosa

Click here to view
Figure 3: Ultrasonographic appearance of the lesion

Click here to view


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)

Click here to view



  Discussion Top


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.[3] 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.[5] 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.[2] Most hemangiomas are present at birth or appear shortly after and involute by the age of 10–15 years.[2] 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.[4],[6] 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.[1],[5]

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.[7]

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.[4],[8]

Sclerosing agents are tissue irritants that injure the endothelium resulting in necrosis, fibrosis, and obliteration of the lesion.[4],[9] 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.[10]

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.[9]

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.[9] Easy availability, effectiveness of action, and tolerance by the body with minimal side effects makes it the sclerosing agent of choice.[9] 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.[4]


  Conclusion Top


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

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Calisaneller T, Ozdemir O, Yildirim E, Kiyici H, Altinörs N. Cavernous hemangioma of temporalis muscle: report of a case and review of the literature. Turk Neurosurg 2007;17:33-6.  Back to cited text no. 1
    
2.
Taksande AM, Vilhekar KY. Cavernous hemangioma of the buccal mucosa in child. J Chin Clin Med 2008;3:95-7.  Back to cited text no. 2
    
3.
Torres-Domingo S, Bagan JV, Jiménez Y, Poveda R, Murillo J, Díaz JM, et al. Benign tumors of the oral mucosa: a study of 300 patients. Med Oral Patol Oral Cir Bucal 2008;13:E161-6.  Back to cited text no. 3
    
4.
Oak SN, Viswanath N. Management of hemangiomas in children. Indian J Dermatol Venereol Leprol 2006;72:1-4.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Greenberg MS, Glick M. Burket's Oral Medicine: Diagnosis and Treatment. 10th ed. India: Elsevier; 2003.  Back to cited text no. 5
    
6.
Oghan F, Ozturk O, Egeli E, Alper M, Harputluoglu U. Unusual presentation of cavernous hemangioma of the palatine tonsil. Duzce Tip Fak Derg 2004;2:34-6.  Back to cited text no. 6
    
7.
Corrêa PH, Nunes LC, Johann AC, Aguiar MC, Gomez RS, Mesquita RA. Prevalence of oral hemangioma, vascular malformation and varix in a Brazilian population. Braz Oral Res 2007;21:40-5.  Back to cited text no. 7
    
8.
Gomes CC, Gomez RS, do Carmo MA, Castro WH, Gala-García A, Mesquita RA. Mucosal varicosities: case report treated with monoethanolamine oleate. Med Oral Patol Oral Cir Bucal 2006;11:E44-6.  Back to cited text no. 8
    
9.
Saraf S. Role of soium tetra decyl sulphate in venous malformations. Indian J Dermatol 2006;51:258-61.  Back to cited text no. 9
  Medknow Journal  
10.
Hassani A, Khojasteh A, Vahid R. Management of mandibular vascular malformation with sclerotherapy. Report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:99-103.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed1633    
    Printed15    
    Emailed0    
    PDF Downloaded245    
    Comments [Add]    

Recommend this journal