A rare case of tongue and lip hemangioma in an adult patient

Abstract

Sir, Oral hemangiomas are common injuries in pediatric patients, but they are rarely seen in adult patients because they are usually treated early. The hemangioma of the mucosa typically appears as a soft mass, moderately well-circumscribed, painless, and red. The most superficials are often lobulated and turn pale at the acupressure. Deeper lesions tend to be dome-shaped with a surface area of normal or blue coloration, but rarely turn pale. The hemangioma is a characteristic lesion formed by an excess of vessels, mostly veins and capillaries, soaked with blood, or variously thrombosed. It is almost always not encapsulated. The lesions are classified into several categories: capillary hemangioma, cavernous hemangioma, epithelioid hemangioma, intramuscular hemangioma, and sinusoidal hemangioma. Hemangiomas include numerous vessels that are interwoven, lined by endothelial cells with relatively flat or swollen cores, depending on whether the injury is recent or old [1]. In most cases, the tumors of the tongue are localized on the surface of the mucosa and are easily accessible; the diagnosis can be made already to direct observation [2]. Treatment options for injuries of this kind, and which need a therapy, are various and include invasive and noninvasive treatments. The noninvasive therapy involves the administration of systemic and intralesional corticosteroids [3]. In the event of adverse effects occurring from corticosteroids or the intervention is not decisive, surgical procedures must be undertaken. Because the surgery can be complicated by an abnormal bleeding, surgical resection may be preceded by chemoembolization. The chemoembolization was also utilized as the only form of treatment for unresectable lesions [4, 5]. A less-invasive alternative is represented by the laser. While representing a valid alternative to invasive surgery, this technique is not free from side effects and the risk of recurrence is also high [6, 7]. A rare case of tongue and lip hemangioma in a 25year-old Asian man with a red and soft swelling localized on the anterolateral left and frontal regions of the tongue and a similar lesion on left side of the lower lip arrived at our outpatient clinic of Plastic and Reconstructive Surgery. The lesion on the lip was 4×1.5 cm, the one on the tongue was 6×3 cm (Figs. 1 and 2). The patient reported that the lesions were congenital and causes pain and bleeding during the movements of the tongue like speaking, drinking, and eating. The treatment of choice in this case was the chemoembolisation by alcohol, and there have only been two sessions where the alcohol was inoculated into both lesions after local anesthesia. Within a week of the first session, a significant reduction in mass of the two hemangiomas was already visible. After the second session, the patient returned to our clinic for an assessment at 1 month. The two lesions had both almost completely disappeared and therefore it was not necessary to supply a third inoculation. No sign of relapse was shown in the following 6 months, and the patient was advised to undergo one or two sessions of argon laser therapy to remove all traces of injuries, but he refused as he believed he was already fully satisfied with both functional and esthetic outcomes. The technique of chemoembolization with alcohol was adopted because surgery would be too invasive and with not very good esthetic results. The superficial P. Fino : P. Fioramonti :D. Massera :N. Scuderi Department of Plastic Reconstructive and Aesthetic Surgery, University of Rome “La Sapienza”, Policlinico Umberto I, Viale del Policlinico, 155, 00161 Rome, Italy