|Year : 2015 | Volume
| Issue : 2 | Page : 291-293
Sclerotherapy: A conservative approach in the treatment of oral hemangiomas
Harisha Aitha, Jitender Reddy Kubbi, Ramlal Gantala, Navadeepak Kumar Korvipati
Department of Oral Medicine and Radiology, SVS Institute of Dental Sciences, Mahabubnagar, Telangana, India
|Date of Submission||27-Oct-2014|
|Date of Acceptance||11-Oct-2015|
|Date of Web Publication||21-Nov-2015|
SVS Institute of Dental Sciences, Appanapally, Mahabubnagar - 509 002, Telangana
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Hemangiomas are one of the most common neoplasms of infancy with an estimated prevalence of 1-3% among neonates and 10% among children of 1 year of age. It has a female predominance and occurs more frequently among Caucasians than other racial groups. Sixty percent of hemangiomas arise in the head and neck. In 80% of cases, hemangiomas occur as single lesions. They are probably developmental rather than neoplastic in origin. Despite their benign origin and behavior, hemangioma in the oral cavity is always of clinical importance to the dental profession and requires appropriate clinical management as sometimes it is associated with complications like bleeding and ulceration. Here, we report a case of hemangioma of tongue treated with sodium tetradecyl sulfate, a sclerosing agent.
Keywords: Hemangioma, sclerotherapy, sodium tetradecyl sulfate
|How to cite this article:|
Aitha H, Kubbi JR, Gantala R, Korvipati NK. Sclerotherapy: A conservative approach in the treatment of oral hemangiomas. J Indian Acad Oral Med Radiol 2015;27:291-3
|How to cite this URL:|
Aitha H, Kubbi JR, Gantala R, Korvipati NK. Sclerotherapy: A conservative approach in the treatment of oral hemangiomas. J Indian Acad Oral Med Radiol [serial online] 2015 [cited 2019 Dec 7];27:291-3. Available from: http://www.jiaomr.in/text.asp?2015/27/2/291/170162
| Introduction|| |
Vascular anomalies are a heterogeneous group of congenital lesions of abnormal vascular development and may occur anywhere on the body. A hemangioma is a benign lesion of blood vessels or vascular elements. Although hemangiomas of the head and neck are common, these tumors are relatively rare in the oral cavity, especially in oral soft tissue. In the oral cavity, there are most common in tongue, floor of the mouth, buccal mucosa, and lips.  They typically present at birth, enlarge during the first year of life, and then usually spontaneously involute by 5 years of age.
| Case Report|| |
A 45-year-old male patient reported to the Department of Oral Medicine and Radiology, SVS Institute of Dental Sciences, Mahabubnagar, with a swelling on the posterior region of the tongue since he was 5 years old. Patient was otherwise asymptomatic, but he gave a history of bleeding from the lesional site while masticating. His past medical and dental history was non-contributory. Local examination revealed a solitary, sessile, well-defined, oval-shaped swelling of size 2 × 2.5 cm on the posterior region of the anterior two-thirds of the dorsum of the tongue, which was bluish red to erythematous in color and non-tender [Figure 1]. Diascopy revealed that the swelling was compressible with blanching. A provisional diagnosis of hemangioma involving the tongue was made. Treatment was planned with a sclerosing agent, sodium tetradecyl sulfate (STS). A test dose was given in the left arm to check for hypersensitivity and the patient was recalled after 3 days.
At the first visit, after anesthetizing the area with lignocaine HCl, evacuation of blood was done using digital pressure. Then intralesional sclerosing agent, 3% STS in aliquots of 0.05-0.1 ml, with an insulin syringe was administered at the periphery of the lesion at multiple sites with the total dose not exceeding 0.9 ml. The digital pressure was slowly released after few minutes. Patient was recalled after 15 days when we noticed minimal to moderate regression of the lesion in terms of size [Figure 2], after which 0.05-0.1 ml of 3% STS was administered in the center of the lesion. During the third visit after 15 days, there was marked reduction in the size of the lesion [Figure 3]. Subsequent periodic visits did not reveal any dimensional changes of the lesion.
|Figure 2: Moderate regression of lesion noticed 15 days after sclerotherapy|
Click here to view
|Figure 3: Regression of tongue lesion noticed 1 month after sclerotherapy|
Click here to view
| Discussion|| |
Hemangiomas are defined as vascular tumors occurring in infancy that undergo a rapid phase of growth and expansion followed by a period of slow and sustained growth during childhood. The term comprises the Greek words "hema" which means blood, "angeio" meaning vessel, and "oma" meaning tumor.  The first case of hemangioma was reported in 1841 as "bluish excrescence" and "erectile tissue."  Head and neck region possesses complete rich and intricate blood vessels, which might be a predisposing factor for variety of vascular lesions. Based on their clinical behavior and endothelial cell characteristics, in 1982, Mulliken and Glowacki categorized these vascular lesions into vascular malformations and hemangiomas.  Based on their histological appearance, hemangiomas are classified as capillary lesions, cavernous lesions, and mixed lesions.
Clinically hemangiomas are soft, flat or raised, sessile or pedunculated, and painless. They may be smooth or irregularly bulbous in outline, seldom well circumscribed. The color varies from deep red to purple, and the tumor blanches on application of pressure.  Hemangiomas range from a few millimeters to several centimeters in diameter.  Complications include pain, scarring, disfigurement, and less commonly, infection and anemia secondary to bleeding. The diagnosis of a hemangioma is best made by clinical history and physical examination. In cases of unclear diagnosis, the best radiographic modalities to use are either a Doppler ultrasound or magnetic resonance imaging (MRI). 
Intervention in vascular lesions is carried out only if they present with cosmetic and functional problems. Most hemangiomas do not require immediate intervention and 90% can be expected to undergo gradual involution before the age of 9 years.  The management of hemangiomas of the oral mucosa varies according to the age of the patient, size of the lesion, site of involvement, and the clinical nature of the hemangioma. The range of treatment includes steroid therapy, carbon dioxide or argon laser therapy, interferon alpha, sclerosing agents, surgical excision with or without ligation of vessels, and embolization. 
Sclerotherapy is a procedure used to treat vascular malformations with the help of sclerosing agents, which are tissue irritants that cause vascular thrombosis and endothelial damage, leading to endofibrosis and vascular obliteration when injected into or adjacent to blood vessels.  The most versatile and effective sclerosant available is 1% and 3% STS, which is the detergent solution of the sclerosing agent. The advantages of STS detergent sclerosants are the absence of pain with intravascular injection and a very low incidence of allergic reactions. There is also no hemolysis as a direct effect of the drug and, therefore, the potential for less hyperpigmentation.  Sclerotherapy may cause complete regression of low vascular lesions.
| Conclusion|| |
The choice of therapy of hemangiomas depends on the careful assessment of factors (anatomic location, accelerating growth, significant functional disturbances, and unaesthetic markings) along with a comparison of risks and benefits of the treatment. Sclerotherapy is effective in more than 90% of hemangiomas, but not in involuting cases.  It is of great help to the patient if invasive procedures can be avoided and especially, a relief to the physicians if they can cure a hemangioma by this conservative approach of sclerotherapy before or instead of the potentially dangerous surgery.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Qiam F, Khan M, ud Din Q. Mucosal venous hemangiomas of the oral cavity - An analysis of 43 cases and literature review. Journal of Khyber College of Dentistry 2011;2:1-5.
Foco F, Brkic A. Vascular Anomalies of the Maxillofacial Region: Diagnosis and Management. In: Motamedi MH, editor. A Textbook of Advanced Oral and Maxillofacial Surgery. Vol. 11. Rijeka, Croatia: InTech; 2013. p. 303-20.
Richter GT, Friedman AB. Hemangiomas and vascular malformations: Current theory and management. Int J Pediatr 2012;2012:645678.
Bharathi V, Singh J. Capillary hemangioma of palatal mucosa. J Indian Soc Periodontol 2012;16:475-8.
Drolet BA, Esterly NB, Frieden IJ. Hemangiomas in children. N Engl J Med 2006;341:173-81.
Oak SN, Viswanath N. Management of hemangiomas in children. Indian J Dermatol Venereol Leprol 2006;72:1-4.
Bayrak S, Dalsi K, Hamza T. Capillary hemangioma of the palatal mucosa: Report of an unusual case. SÜ Dishek Fak Derg 2010;19:87-9.
Croffie J, Somogyi L, Chuttani R, DiSario J, Liu J, Mishkin D, et al
.; Technology Assessment Committee. Sclerosing agents for use in GI endoscopy. Gastrointest Endosc 2007;66:1-6.
Dietzek CL. Sclerotherapy: Introduction to solutions and techniques. Perspect Vasc Surg Endovasc Ther 2007;19:317-24.
Swain S, Prusty N. Use of setrol in hemangioma (A case report). Int J Curr Res 2013;5:1290.
[Figure 1], [Figure 2], [Figure 3]