|Year : 2016 | Volume
| Issue : 2 | Page : 188-190
Sclerotherapy for oral hemangioma
Navadeepak Korvipati1, Kotya Naik Maloth2, Sunitha Kesidi2, Shefali Waghray3
1 Department of Oral Medicine and Radiology, SVS Institute of Dental Sciences, Mahabubnagar, Telangana, India
2 Department of Oral Medicine and Radiology, Mamata Dental College and Hospital, Khammam, Telangana, India
3 Department of Oral Medicine and Radiology, Panineeya Mahavidhyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
|Date of Submission||07-Sep-2015|
|Date of Acceptance||21-Nov-2016|
|Date of Web Publication||02-Dec-2016|
Dr. Kotya Naik Maloth
Department of Oral Medicine and Radiology, Mamata Dental College and Hospital, Khammam - 507 002, Telangana
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Hemangiomas are well-known benign neoplasms of the body most commonly occurring in the head and neck region and less commonly in the oral cavity. The predominant site of occurrence, in the oral cavity, is lips followed by gingiva, tongue and palate. Treatment is primarily dependent on correct diagnosis of the lesion and its anatomic location. Here, we report a case of hemangioma on posterior third of the tongue in 34-year-old male patient, who was treated by sclerotherapy with sodium tetradecylsulphate (setrol) sclerosing agent.
Keywords: Sclerosing agent, sclerotherapy, vascular lesions
|How to cite this article:|
Korvipati N, Maloth KN, Kesidi S, Waghray S. Sclerotherapy for oral hemangioma. J Indian Acad Oral Med Radiol 2016;28:188-90
| Introduction|| |
Hemangiomas are most common soft tissue benign tumors, composed of blood vessels, and occur in the head and neck region (60%) and less commonly in the oral cavity; oral cavity if affected involves gingiva followed by the lips, tongue and palate.  The peak incidence of occurrence is soon after birth or in early infancy; it rarely lasts beyond 9 years of age, however, some cases with onset in adulthood have also been reported.  Females are predominantly affected than males with a male to female ratio of 3:1.  In 1982, Mullikan and Glovack proposed a classification system for vascular lesions based on cellular method into two types. The first type exhibits endothelial proliferation (hemangioma) and the second type does not exhibit endothelial proliferation (vascular malformation). 
| Case Report|| |
A 34-year-old male patient reported to our department with a chief complaint of swelling on the tongue since birth; the swelling was initially smaller in size and gradually progressed to the present size and was not associated with pain. On intraoral examination, a solitary, sessile, oval-shaped swelling measuring approximately 3 × 2 cm in diameter was seen on the dorsum of tongue, i.e., in front of the sulcus terminalis. Color over the swelling was reddish blue. On palpation, swelling was measuring approximately 3 × 2 cm in diameter with a smooth surface, was normothermic, nontender, soft in consistency; the swelling was compressible but not reducible and was fixed to the underlying structures [Figure 1]. Diascopy was performed which was positive. Based on the history and clinical findings, a provisional diagnosis of hemangioma was established with a differential diagnosis of vascular malformations, Kaposi sarcomas, pyogenic granuloma and oral squamous cell carcinoma.
Routine blood investigations were within normal limits. Further investigations, such as color Doppler ultrasonography was performed, which revealed hypoechoic lesion, with increased vascular signals within the lesion observed on the posterior aspect of the tongue, suggestive of a vascular lesion [Figure 2]. Once it was confirmed as a vascular lesion, the decision was taken to employ sclerotherapy with 0.5 ml of 1% (10mg) sodium tetradecylsulphate (Setrol), which was administered using an insulin needle on three occasions via slow infiltration at center of the lesion with 1 week interval between applications. Currently, the patient is under follow-up since 6 months with a good prognosis. The lesion has reduced in size in comparison with its initial size [Figure 3] and [Figure 4].
|Figure 2: Color Doppler ultrasonography showing hypoechoic area with increased vascular signals within the lesion|
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| Discussion|| |
Oral hemangiomas occur less commonly than those in the head and neck region. They are of developmental or congenital origin, grow rapidly in size till puberty and then regress, however, few lesions persist later in adult life,  as seen in our case where the patient was 34 years old. The exact etiology of vascular lesions is unknown, but according to few authors, angiogenesis plays a vital role in the pathogenesis of vascular lesion formation. Cytokines such as basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) induce the process of angiogenesis and the factors which conquer angiogenesis are gamma interferon, tumor necrosis factor beta, and transforming factor-beta. 
With respect to the gender, Dilsiz et al.,  Kripal et al.,  and Jeddy et al.  in their studies observed that females were more commonly affected than males, however, in our case the patient was male. With respect to the site, Kocer et al.  and Acikgoz et al.  suggested that head and neck region is more commonly affected than oral cavity. If oral cavity is involved, gingiva is the common site followed by lip, tongue and palate. In the present case, tongue was involved.
Hemangiomas of the tongue are rare lesions which can cause distressing problem to the patients, producing cosmetic deformity, recurrent hemorrhage, and functional problems with speaking, mastication, and deglutition.  Management of hemangiomas depends on various factors such as their location, size and nature (venous or arterial), and most true hemangiomas require no intervention. However, 10-20% require treatment. For smaller and peripheral lesions, treatment options include sclerotherapy, conventional surgical excision, laser treatment, radiotherapy, electrocoagulation and cryotherapy.  In the present case, we opted for sclerotherapy because the lesion was small in size and because it is a simple and safe technique.
Various sclerosing agents such as sodium morrhuate, sodium psylliate, hypertonic glucose solution, sodium tetradecylsulphate and ethanolamine oleate are available.  In this case, we selected 0.5 ml of 1% (10 mg) Setrol for management because it is approved by the Food and Drug Association, is easily available, safe, reliable and is an effective drug with minimal side effects. The sclerosing agent should be administered using an insulin needle at the centre of the lesion to avoid necrosis of the surrounding tissues, thereby causing fibrosis of the lesion and ultimately leading to complete regression,  as in the present case. Sclerotherapy is contraindicated in uncontrolled diabetic patients in areas of secondary infection and expectant mothers, due to its teratogenic effects. 
| Conclusion|| |
Hemangiomas are common developmental vascular lesions, and most of them regress after puberty. However, few vascular lesions persist later in adult life, as in our case. Such lesions can be treated with simple and safe techniques, such as sclerotherapy, with less complications compared to other treatment modalities. However, we conclude that sclerotherapy is the therapy of choice in the isolated vascular lesions involving the body of the tongue and it is more likely to result in the patient's esthetic recovery.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]