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HEMANGIOMA – A CASE
REPORT
INDIAN DENTAL ACADEMY
Leader in continuing Dental
Education
www.indiandentalacademy.com
Name : Mr. Vijayanand
Age/Sex : 20yrs/ male
www.indiandentalacademy.com
CHIEF COMPLAINT
Swelling in the lower left side of face since birth.
HOPI
Swelling is present since birth which has increa...
Patient underwent surgery for the same swelling twice. First at
the age of 2 months and second, at the age of 2 years.
But...
PAST MEDICAL HISTORY
No History Of Diabetes Mellitus,
Hypertension ,
Asthma ,
Bleeding disorder ,
Allergic to drugs
PAST D...
PAST SURGICAL HISTORY
Underwent uneventful surgeries twice for the same swelling.
PERSONAL HISTORY
No habits of smoking / ...
FAMILY HISTORY
Single,
Only son,
Both parents are hale and healthy.
CLINICAL EXAMINATION
Patient is calm, conscious, coher...
VITAL SIGNS -
Temperature
Pulse
Respiratory Rate
Blood Pressure
No signs of anaemia, cyanosis, and jaundice.
Clubbing and ...
EXTRAORAL EXAMINATION
www.indiandentalacademy.com
INTRAORAL EXAMINATION
SOFT TISSUE
Labial mucosa:
Left half of the lower lip has a swelling that is continuous with that
of...
Buccal mucosa:
www.indiandentalacademy.com
PROVISIONAL DIAGNOSIS
HEMANGIOMA of left side cheek and lip.
DIFFERENTIAL DIAGNOSIS
A-V Malformation.
www.indiandentalacad...
INVESTIGATION
CT- Carotid Angiogram
(volume scan of neck was
done with I.V. contrast)
www.indiandentalacademy.com
IMPRESSION
1)Left buccinator space soft tissue lesion with a
calcific foci.
2)With contrast there are two small clusters o...
FINAL DIAGNOSIS
HEMANGIOMA of left side cheek and lip.
www.indiandentalacademy.com
TREATMENT
Surgical Excision.
POST-OPERATIVE
www.indiandentalacademy.com
Two Months Later
www.indiandentalacademy.com
HEMANGIOMA
is a tumorlike malformation composed of seemingly
disorganized masses of endothelium-lined vessels that are
fil...
CLINICAL FEATURES
85% of childhood-onset
Spontaneously regress after puberty.
Reddish blue - closer to epithelium; deep bl...
RADIOLOGICAL FEATURES
Radiographically – intra osseous hemangioma – honeycombed
pattern.
HISTOLOGICAL FEATURES
Many small ...
TREATMENT
Surgical excision and injecting sclerosing agents.
Hemangiomas respond to steroids in 30 to 60% of cases
(Subglo...
CONCLUSION
The clinical presentation of vascular congenital abnormalities
range from, asymptomatic birthmark to life threa...
Various sclerosing agents are proved ineffective in treating high-
flow lesions.
Ligation of external carotid artery also ...
REFERENCES:
1. Noninvoluting Congenital Hemangioma: A Rare Cutaneous
Vascular Anomaly
Plast. Reconstr. Surg. 107: 1647, 20...
4. Management of subglottic hemangioma
Current Opinion in Otolaryngology & Head and Neck
Surgery 2004,12:509–512
5. Manage...
Thank
You
www.indiandentalacademy.com
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HEMANGIOMA / oral surgery courses

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.

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HEMANGIOMA / oral surgery courses

  1. 1. HEMANGIOMA – A CASE REPORT INDIAN DENTAL ACADEMY Leader in continuing Dental Education www.indiandentalacademy.com
  2. 2. Name : Mr. Vijayanand Age/Sex : 20yrs/ male www.indiandentalacademy.com
  3. 3. CHIEF COMPLAINT Swelling in the lower left side of face since birth. HOPI Swelling is present since birth which has increased in size with his age. It initially was the of a marble, which has gradually increased to the present size of an orange. www.indiandentalacademy.com
  4. 4. Patient underwent surgery for the same swelling twice. First at the age of 2 months and second, at the age of 2 years. But the swelling again increased in size. He was advised to wait until his growth is completed. Patient gives history of discharge of blood, on accidental trauma to the swelling & decreases in size of swelling on pressing which regains its size within a minute www.indiandentalacademy.com
  5. 5. PAST MEDICAL HISTORY No History Of Diabetes Mellitus, Hypertension , Asthma , Bleeding disorder , Allergic to drugs PAST DENTAL HISTORY First dental visit. www.indiandentalacademy.com
  6. 6. PAST SURGICAL HISTORY Underwent uneventful surgeries twice for the same swelling. PERSONAL HISTORY No habits of smoking / chewing tobacco / alcohol consumption www.indiandentalacademy.com
  7. 7. FAMILY HISTORY Single, Only son, Both parents are hale and healthy. CLINICAL EXAMINATION Patient is calm, conscious, coherent and co-operative. He is moderately built and moderately nourished. www.indiandentalacademy.com
  8. 8. VITAL SIGNS - Temperature Pulse Respiratory Rate Blood Pressure No signs of anaemia, cyanosis, and jaundice. Clubbing and pedal edema - Not seen. REVIEW OF SYSTEMS On review of systems -- All systems were normal Normal www.indiandentalacademy.com
  9. 9. EXTRAORAL EXAMINATION www.indiandentalacademy.com
  10. 10. INTRAORAL EXAMINATION SOFT TISSUE Labial mucosa: Left half of the lower lip has a swelling that is continuous with that of buccal mucosa. www.indiandentalacademy.com
  11. 11. Buccal mucosa: www.indiandentalacademy.com
  12. 12. PROVISIONAL DIAGNOSIS HEMANGIOMA of left side cheek and lip. DIFFERENTIAL DIAGNOSIS A-V Malformation. www.indiandentalacademy.com
  13. 13. INVESTIGATION CT- Carotid Angiogram (volume scan of neck was done with I.V. contrast) www.indiandentalacademy.com
  14. 14. IMPRESSION 1)Left buccinator space soft tissue lesion with a calcific foci. 2)With contrast there are two small clusters of peripherally enhancing vessels, with no significant enhancement of mass lesion, no prominent artery feeders seen. A few veins are seen draining into left internal jugular vein and anterior jugular vein. findings suggests the possibility of soft tissue hemangioma. www.indiandentalacademy.com
  15. 15. FINAL DIAGNOSIS HEMANGIOMA of left side cheek and lip. www.indiandentalacademy.com
  16. 16. TREATMENT Surgical Excision. POST-OPERATIVE www.indiandentalacademy.com
  17. 17. Two Months Later www.indiandentalacademy.com
  18. 18. HEMANGIOMA is a tumorlike malformation composed of seemingly disorganized masses of endothelium-lined vessels that are filled with blood and connected to the main vascular system. Vascular malformations are subcategorized according to the predominant anomalous channels as either low-flow (capillary, venous, or lymphatic malformations), or fast-flow (arteriovenous fistulas and arteriovenous malformations). DISCUSSION www.indiandentalacademy.com
  19. 19. CLINICAL FEATURES 85% of childhood-onset Spontaneously regress after puberty. Reddish blue - closer to epithelium; deep blue - little deeper in the connective tissue. Raised and nodular Blanch under pressure Thrombi in angiomas may eventually calcify - radiographically evident. ORAL MANIFESTATIONS Flat or raised lesion of the mucosa, usually deep red or bluish red and seldom well circumscribed. Tongue, lip mucosa www.indiandentalacademy.com
  20. 20. RADIOLOGICAL FEATURES Radiographically – intra osseous hemangioma – honeycombed pattern. HISTOLOGICAL FEATURES Many small capillaries lined by a connective tissue stroma of varying density. INVESTIGATIONS Angiography is considered most definitive of the studies. Two of the most widely available methods in MR Angiography are time of flight (TOF) and phase contrast (PC) Contrast – enhanced MRI (hemangioma/ lymphangioma). www.indiandentalacademy.com
  21. 21. TREATMENT Surgical excision and injecting sclerosing agents. Hemangiomas respond to steroids in 30 to 60% of cases (Subglottic hemangioma) In pediatric patients with massive or life-threatening hemangiomas, interferon alfa-2a therapy is an effective treatment option. www.indiandentalacademy.com
  22. 22. CONCLUSION The clinical presentation of vascular congenital abnormalities range from, asymptomatic birthmark to life threatening situation like congestive heart failure or exsanguinating hemorrhage. Those afflicted will seek help from many different physicians and undergo repetitive examination for diagnosis, which frequently results in failed attempts of treatment, leading to exacerbation of symptoms, lesion recurrence, and disability. www.indiandentalacademy.com
  23. 23. Various sclerosing agents are proved ineffective in treating high- flow lesions. Ligation of external carotid artery also fails usually because of many anastomoses, which promote the rapid appearance of a collateral circulation. Embolization combined with surgical treatment is still the most common approach. www.indiandentalacademy.com
  24. 24. REFERENCES: 1. Noninvoluting Congenital Hemangioma: A Rare Cutaneous Vascular Anomaly Plast. Reconstr. Surg. 107: 1647, 2001. 2. Three-dimensional identification of hemangiomas and feeding arteries in the head and neck region using combined phase- contrast MR angiography and fast asymmetric spin-echo sequences Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:609-13 3. . An Update on the Treatment of Hemangiomas in Children With Interferon Alfa-2a Arch Otolaryngol Head Neck Surg.1999;125:21-27 www.indiandentalacademy.com
  25. 25. 4. Management of subglottic hemangioma Current Opinion in Otolaryngology & Head and Neck Surgery 2004,12:509–512 5. Management of mandibular vascular malformations with sclerotherapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:99-103 6. Burket’s Text Book of Oral Medicine - Martin S. Greenberg, Michael Glick 7. Differential Diagnosis of Oral And Maxillofacial Lesions - Norman K. Wood , Paul W. Gauz 8. Shafer’s Text Book Of Oral Pathology - R Rajendran, B Sivapadasundharam www.indiandentalacademy.com
  26. 26. Thank You www.indiandentalacademy.com

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