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Oral Hemangiomas Follow-up

  • Author: Steven Brett Sloan, MD; Chief Editor: William D James, MD  more...
 
Updated: Feb 09, 2016
 

Further Inpatient Care

Many patients who undergo treatment of oral hemangiomas often require multiple follow-up therapies. The additional treatments may include further treatments of the same type as the initial treatment or combinations of other modalities.

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Complications

Complications of oral vasoformative tumors can be divided into 2 general types: complications related to the disease process and complications from treatment.

Complications from the disease process include hemorrhage, high-output states, infection, function problems (eg, airway, vision, hearing), thrombocytopenia, and ulceration. Ulceration is the most common complication of capillary hemangiomas and typically occurs centrally in large lesions. It may result in scarring and does not hasten resolution of the lesion. Ulceration may become secondarily infected and is readily treated with local wound care. Bleeding is one of the most common reasons that patients with oral hemangiomas and vascular malformations seek care.

Complications from treatment of hemangiomas are many, and, because of this, many lesions are left untreated. Treatment of the nonproliferating lesion with minimal functional impairment becomes a risk-to-benefit decision. With all treatments, a common complication is persistence or recurrence of disease.

With the 2 medical treatments, steroids and interferons, the complications are the well-known adverse effects of the drugs. No special complications are related to the treatment of vasoformative tumors, other than nonresponse to treatment.

With embolotherapy, complications can range from minor to life threatening. Complications are often related to specific kinds of embolizing devices and techniques. For embolization in general, the commonly reported complications include the risks of superselective catheterization, which include pain, infections, fever, organ infarction, and abscesses related to the introduction of external agents; exclusion of a vital segment of the blood supply; release of pyrogenic materials into the circulation; migration of emboli into other parts of the body; and general effects of drugs, such as thrombin and ethanol. Complication rates for ethanol embolization are 7.5-23%, including nerve palsies and at least 2 reported fatalities.[10] When used permucosally for the treatment of oral hemangiomas, the only reported complication was a mucosal slough that spontaneously healed.[45]

O'Donovan et al[48] reported that 3 of 21 patients had minor skin ulceration following sclerosis with STS. Others have reported no complications with the use of STS injected intralesionally.[50, 51, 52]

Complications related to sclerotherapy include the following: skin necrosis (4%), temporary myoglobinuria (2%), and airway compromise (1%).

As lesions become larger and, more importantly, as the flow in the lesions becomes greater, the complications increase.

Kane et al[25] categorized the complications from ablative surgery following embolotherapy or sclerotherapy for hemangiomas and vascular malformations into immediate and late complications (see Table 2 below).

Table 2. Complications From Ablative Surgery Following Embolotherapy or Sclerotherapy for Hemangiomas and Vascular Malformations (Open Table in a new window)

Complications Hemangiomas, % Vascular Malformations, %
Immediate Complications
Hemorrhage 27 60
Airway compromise 2 10
Hematoma 14 14-30
Skin necrosis 12 10-30
Coagulopathy 7 14-20
Late Complications
Restricted oral opening 8 27-40
Malocclusion 8 20-40
Drooling 23 40-47
Dysphagia 23 20-27

 

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Prognosis

The morbidity of oral hemangiomas ranges from surface discoloration to life-threatening functional compromise of the airway or hemorrhage. Fatal spontaneous hemorrhage from jaw hemangiomas has been documented in 25 cases.[17] Significant morbidity can also occur from many of the treatments of hemangiomas, and biopsy of these lesions is also fraught with danger.

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Contributor Information and Disclosures
Author

Steven Brett Sloan, MD Associate Professor, Department of Dermatology, University of Connecticut School of Medicine; Residency Site Director, Connecticut Veterans Affairs Healthcare System; Assistant Clinical Professor, Yale University School of Medicine

Steven Brett Sloan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Connecticut State Medical Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Journal of the American Academy of Dermatology;Up to Date;Medical Review Institute of America.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Neil Shear, MD Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Women's College Health Sciences Center and Women's College Hospital, Canada

Neil Shear, MD is a member of the following medical societies: Canadian Medical Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Dermatology Association, American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics

Disclosure: Nothing to disclose.

Acknowledgements

Randall Wilk, MD, DDS, PhD Associate Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Science Center

Randall Wilk, MD, DDS, PhD is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons, American Dental Association, and American Medical Association

Disclosure: Nothing to disclose.

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Table 1. Classification of Vasoformative Tumors
Vasoformative Tumor New Nomenclature Old Nomenclature
Hemangiomas    
  Capillary hemangioma Strawberry hemangioma
    Juvenile hemangioma
  Cavernous hemangioma  
  Mixed hemangioma Parotid hemangioma
Vascular malformations    
  Venous malformation Cavernous hemangioma
    Hemangiomatosis
  Intramuscular venous malformation Intramuscular hemangioma
  Capillary malformation Capillary hemangioma
    Port-wine stain
  Arteriovenous malformation Arteriovenous hemangioma



Arterial angioma



Arteriovenous aneurysm



Cirsoid angioma



Red angioma



Serpentine aneurysm



  Lymphatic malformation Capillary lymphangioma



Cavernous lymphangioma



Lymphangioma



Cystic hygroma



Table 2. Complications From Ablative Surgery Following Embolotherapy or Sclerotherapy for Hemangiomas and Vascular Malformations
Complications Hemangiomas, % Vascular Malformations, %
Immediate Complications
Hemorrhage 27 60
Airway compromise 2 10
Hematoma 14 14-30
Skin necrosis 12 10-30
Coagulopathy 7 14-20
Late Complications
Restricted oral opening 8 27-40
Malocclusion 8 20-40
Drooling 23 40-47
Dysphagia 23 20-27
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