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  • The Internet Journal of Surgery
  • Volume 7
  • Number 2

Original Article

Huge Hemangioma Of The Face

A Hussain, E Geddoa, H Almusawy

Keywords

hemangioma, vascular malformations

Citation

A Hussain, E Geddoa, H Almusawy. Huge Hemangioma Of The Face. The Internet Journal of Surgery. 2005 Volume 7 Number 2.

Abstract

A 10 months girl infant was brought by her family with a progressive swelling of left side of face since birth involving nose and obscuring left orbit; associated with occasional mild bleeding. What it could be:
1.Malignant tumor
2.Abcess
3.Hemangioma
4.Bone tumor

 

Introduction

The aim of presenting this case is to see the extreme of hemangioma presentation, with review of literatures about the methods of treatment.

Case Report

This girl infant was brought to the outpatient clinic at Alburaihy hospital, Taiz, YEMEN Sept; 2004. The family gave a history of progressive tumor enlargement in the left side of face since birth, of otherwise normal healthy child. This was associated with occasional ulcerations and bleeding.

There were no other abnormalities. And the other history items were unremarkable.

On examination: a huge tumor occupying the left side of the face with ulceration and necrosis. Red margin zone was seen only on the top surrounded by normal skin. The left orbit obscured was by the tumor but the left eye was normal.

Investigations including skull X-Ray were unremarkable. A biopsy was taken from the lesion, which confirmed the vascular malformation as hemangioma.

Figure 1

Discussion

Classification and presentation: The superficial vascular malformation could be divided in to simple, such as infantile hemangioma, port-wine stains, capillarovenous angiodysplasias, and arteriovenous fistulae and malformations and complex type such as systematized (Sturge-Weber and Bonnet-Dechaume-Blanc syndromes, Cobb's metameric angiomatosis, Klippel-Trenaunay and Parkes Weber's syndromes) or disseminated (Weber-Osler-Rendu disease and blue rubber-bleb nevus syndrome (1)

Hemangiomas are the most common benign tumor of infancy. Most hemangiomas remain asymptomatic and can be managed by close observation;(2) There is female predilection especially for syndromes associated with hemangioma (3)

The natural course of immature hemangiomas in infants is well known. A rapid phase of growth from 6 to 8 months is followed by a period of stability then regression. Since approximately 70% of these immature hemangiomas resolve spontaneously, abstention is generally the rule (4)

Treatment

Rapidly proliferating haemangiomas of the face may obscure vision with the development of deprivation amblyopia. Early intervention is required to prevent complications (5)

Therefore, The list of treatment includes surgical and non-surgical treatment. Not all vascular malformations can be successfully treated; in certain cases watchful waiting seems justified but not in cases of severe problems, giant growth, and local complications (6)

Hemangiomas in 74% of the infants demonstrated either good or partial response to treatment with ultrapotent topical corticosteroids (7)

Nowadays, preoperative super selective embolization is recommended to minimize intra operative blood loss. (8) The Nd: YAG laser wavelength exhibits minimal tissue absorption and maximal penetration by comparison with the CO2 laser's maximal absorption and minimal penetration. These properties allow a variety of uses in maxillofacial surgery particularly coagulation of angiomatous lesions (9)

Other non-surgical method of (magnetic resonance) MR-guided sclerotherapy seems feasible for clinical application. (10).

Surgical resection of the tumor can be a challenge; to achieve complete resection, prevention of recurrence and decreasing complications, sugeons adopted different approaches and precautions. One of these approaches is circular excision and purse string (11)

Correspondence to

Mr. A Hussain 4B/Larkway close, Kingsbury, Middlesx NW9 0UE,UK Tel 0044-2082056678. Mob 0044-7949393892 Email azahrahussain@yahoo.com

References

1. Enjolras O, Herbreteau D, Lemarchand F, Riche MC, Laurian C, Brette MD, Merland JJ Hemangiomas and superficial vascular malformations: classification].J Mal Vasc. 1992; 17(1): 2-19
2. Ceisler EJ, Santos L, Blei F. Periocular hemangiomas: what every physician should know: Pediatr Dermatol. 2004 Jan-Feb;21(1):1-9.
3. Gorlin RJ, Kantaputra P, Aughton DJ, Mulliken JB Marked female predilection in some syndromes associated with facial hemangiomas., Am J Med Genet. 1994 Aug 15; 52(2): 130-5.
4. Picard A, Soupre V, Diner PA, Buis J, Goga D, Vazquez MP, Rev Stomato Early surgery of immature hemangiomas with the aid of an ultrasonic scalpel. Apropos of 81 cases, l Chir Maxillofac. 2002 Feb; 103(1): 10-21
5. Schmelzle R Vascular and neural malformations, , Mund Kiefer Gesichtschir. 2000 May; 4 Suppl 1:S76-83.
6. Gorst CM, Munnoch DA, Hancock K. Combined treatment of a proliferative peri-orbital haemangioma with a tuneable dye laser and intra-lesional steroids to prevent deprivation amblyopia.
7. 6. Schmelzle R Vascular and neural malformations, Mund Kiefer Gesichtschir. 2000 May; 4 Suppl 1:S76-83.
8. Garzon MC, Lucky AW, Hawrot A, Frieden IJ. Ultra potent topical corticosteroid treatment of hemangiomas of infancy. J Am Acad Dermatol. 2005 Feb; 52(2): 281-6. 52(2): 130-5.
9. Watzinger F, Gossweiner S, Wagner A, Richling B, Millesi-Schobel G, Hollmann K.Extensive facial vascular malformations and haemangiomas: a review of the literature and case reports. J Craniomaxillofac Surg. 1997 Dec; 25(6): 335-43.
10. Bradley PF,A review of the use of the neodymium YAG lasers in oral and maxillofacial surgery. Br J Oral Maxillofac Surg. 1997 Feb; 35(1): 26-35.
11. Hayashi N, Masumoto T, Okubo T, Abe O, Kaji N, Tokioka K, Aoki S, Ohtomo K. Hemangiomas in the face and extremities: MR-guided sclerotherapy--optimization with monitoring of signal intensity changes in vivo. Radiology. 2003 Feb; 226(2): 567-72.
12. Mulliken JB, Rogers GF, Marler JJ.Circular excision of hemangioma and purse-string closure: the smallest possible scar., Plast Reconstr Surg. 2002 Apr 15; 109(5): 1544-54; discussion 1555.

Author Information

Abdulzahra Hussain, FRCSI,FICS,Dipl(Gen.Surgery)
General Surgery

Emad Geddoa, FRCS (Eng), Msc
General Surgery

Hussein Almusawy
Clinical Fellow, General Surgery

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