Hemangioma- A step by step approach

What is a hemangioma?

Hemangioma is a vascular neoplasm or a vascular anomaly due to proliferation of blood vessels. They occur anywhere in the body, but skin and oral mucosa in the region of the lips, tongue, and buccal mucosa are most commonly affected. Therefore, the dentist or oral surgeon should be informed about their clinical aspect, diagnosis, and therapy. The gold standard for hemangioma treatment, especially for smaller circumscribed lesions and peripheral hemangiomas, is conventional surgical excision. However, complications that arise from conventional invasive surgical procedures such as excessive postoperative bleeding compelled the use of other different therapeutic alternatives including systemic corticosteroids, laser therapy, cauterization, cryotherapy, radiotherapy, and sclerotherapy.



Hemangiomas are more common in girls than in boys. They are more common in premature infants, twins and Caucasian children. Most hemangiomas go through several phases of growth.  Then, they start to go away by themselves.

  1. Most appear during the first weeks of life and grow fast for the first 2 to 3 months.
  2. For the next 3 to 4 months, the hemangioma may grow more slowly.
  3. Then, there is usually a period of no change to the hemangioma.
  4. At around 1 year of age, the hemangioma begins to slowly shrink and fade in color. This happens over the next 1 to 10 years.
If left over skin changes are noticeable there are procedures that may be used when the child is older to correct the changes.  These include surgery and some other treatment modalities. 

Diagnosis

The doctor can usually look at your child’s skin and tell if there is a hemangioma. If the diagnosis is not clear an USG color doppler may be needed.

When Treatment is Needed

The hemangioma may need to be treated if:

  • The skin “breaks down” and an open sore forms.
  • It gets infected (especially if it is in the diaper area).
  • It causes problems with any of the following:
    • Vision
    • Breathing
    • Hearing
    • Eating
    • Diaper changes
  • It is very large or it is a cosmetic concern, such as on the face.

Treatment

Most hemangiomas go away over time without any treatment. If the hemangioma is causing a problem, there are different treatment options. Your child’s doctor will talk with you about the best choice for your child. This may depend on the size, location and behavior of your child’s hemangioma.

  • Beta blocker drugs. In small, superficial hemangiomas, a gel containing the drug timolol may be applied to the affected skin. A severe infantile hemangioma may disappear if treated with an oral solution of propranolol. Treatment usually needs to be continued until about 1 year of age. Side effects can include high blood sugar, low blood pressure and wheezing.
  • Corticosteroid medications. For children who don't respond to beta blocker treatments or can't use them, corticosteroids may be an option. They can be injected into the nodule or applied to the skin. Side effects can include poor growth and thinning of the skin.
  • Laser surgery. Sometimes laser surgery can remove a small, thin hemangioma or treat sores on a hemangioma.
Sclerotherapy of hemangiomas is a relatively simple, effective, and inexpensive method that is a valuable and promising treatment.




Sclerosing agent is being injected to the vascular malformation sites with the help of "bubbling action" using two 10cc plastic syringes, connected and flow being controlled by a tri-channel valve, the valve in turn is connected to a butterfly needle by which the the sclerosing agent is being infused to the site of vascular malformation as we can see in this given video. 



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