Vascular Enlargement of Lower Lip - A

Hemangiomas are benign skin lesions of infancy and childhood, occurring in 1012% of children at 1 year of age. Commonly located in head and neck region (60% of cases) and occur more frequently in the lips, tongue, and palate. 50% of hemangiomas have complete resolution up to 1 year of age. Complications occur only in 20% of the cases; most common is ulceration. Many treatment modalities exist including conservative and surgical methods. When non-operative modalities fail, surgery is usually needed. Small lesions can be treated by horizontal and vertical wedge resections, elliptical excisions and for large vascular lesions; different local and regional flaps are available. This paper reports a case of cavernous hemangioma in a 40 year-old male patient, who underwent simple excision (Reduction cheiloplasty) of the hemangioma of lower lip. One year follow-up shows successful treatment with no recurrence. 1 2 3 4 Himanshu P Singh, Sunil K Mall, Anuj Garg, Saad Ahmed 1,2 Sr. Lecturer, Department of Oral & Maxillofacial Surgery, 3,4 Institute of Dental Sciences, Bareilly Senior Lecturer, Department of Oral Pathology & Microbiology, Dental College, Azamgarh INTRODUCTION : In 1982, Mulliken and Glowacki, classified vascular lesions as haemangiomas or vascular malformations.1,2 The haemangioma is a benign proliferation of endothelial cells common in the head and neck. These lesions are three to five times more common in females, with an even higher female preponderance in hemangiomas that are problematic or associated with structural abnormalities. There is an increased frequency of hemangiomas in premature infants with a reported incidence of 23% in neonates who weigh less than 1200 g. Hemangiomas are unusual in dark-skinned infants.3 The most frequent location for oral haemangiomas is the lip. Treatment is needed to prevent complications such as ulceration, infection, bleeding or obstruction of the airway.1 Historically, hemangiomas have been classified in a variety of ways. An important descriptive classification is related to the depth of soft tissue involvement i.e. superficial, deep, and mixed.4 The term cavernous hemangioma has traditionally been applied when lesional vascular channels are considerably enlarged.4 The large forms of infantile cavernous hemangiomas frequently have accelerated growth and may cause significant functional disturbances and existential complications.5 The Head & Neck region is more commonly affected especially the face, oral mucosa, lips, tongue and trunk. Size can vary from few millimeters to several centimeters (0.25 to 200 cm3). The skin is the organ of most frequent occurrence.6 The clinical appearances of the lesions vary from an anemic spot, at times erythematous, to a small cluster of deep red papules.7 The initiation of lesion occurs with a rapid growth stage, and at the end of the first month of life approximately 90% of the cases become evident. Followed, a stagnation stage is initiated and continues for several months. Then, they involute slowly showing a regression rate of 90% up to 10 years of age. An unbalance in the angiogenesis seems to be main reason for the development of hemangioma, which causes an uncontrolled proliferation of vascular elements,8 associated with substances such as vascular endothelial growth factor (VEGF), basic fibroblast growth factor (BFGF) and indoleamine 2,3-dioxygenase (IDO), which are found in large amount during proliferative stages, although reduced throughout involution stage.5,9 Clinical findings and semiotic maneuvers, such as diascopy or glass-slide pressure are very helpful in differentiating vascular from nonvascular lesions.8 Diagnostic imaging has also a great role in revealing size, extension and location, as well as for follow up of lesions treated under a systemic therapy.10 VASCULAR ENLARGEMENT OF LOWER LIP A CASE REPORT Journal of Dental Sciences University