PC1174: Multiple Untreated Oral Hemangiomas in an Adolescent Patient; A Case Report

Introduction: Infantile hemangiomas (IH) are the most common benign tumor of infancy occurring in 5% of all infants. Early identification of high risk IH can significantly decrease morbidity. Oral hemangiomas (OH) when identified early can be treated safely and decrease need for invasive treatment options.

Case Description: Our patient is a 15-year-old female with hemangiomas of the tongue noted at birth. The lesions became bothersome about 1 year prior to presentation, when a third, more posterior lesion developed and the lesions started to bleed. The patient reported about 2 episodes of bleeding per month, and are associated with color changes to the lesions followed by painful blisters that make it difficult to swallow. Patient was referred to ENT and MRI neck with/without contrast was done, showing a left parapharyngeal mass and a second lesion in the left mylohyoid muscle. Patient was started on oral propranolol 20 mg daily and had mild side effects including drowsiness and intermittent heart palpitations in the morning. After one month of treatment, her dorsal tongue lesions had decreased frequency of bleeding and pain, but her lateral tongue lesion increased in size and continued to have episodes of bleeding and blistering.

Discussion: Most OH will not require treatment, however, for OHs that present with impairment in speech, swallowing, or airway compromise, and for the 10% to 20% of lesions that persist into adolescence, treatment is recommended. Current treatment options include medical and surgical (or interventional) options. Beta-blockers, such as propranolol, are the mainstay of medical treatment for OHs. Oral steroids are not preferred due to their side effect profile. For patients who do not respond to or tolerate medical therapy, surgical or interventional options can be offered. Sclerotherapy would be preferred over surgical resection for large lesions, but there is risk of thrombosis with embolization. Based on MRI, our patient also has an intramuscular hemangioma (IMH). IMH represents less than 1% of all hemangiomas; IMH in the head and neck region account for 15% of those, and occurs mostly in the masseter, temporalis, and trapezius muscles. IMH arising from the mylohyoid muscle are very rare. To our knowledge, there are only a few cases of mylohyoid muscle IMH documented in English literature.

Conclusion: OH are typically diagnosed in children, and the majority of these lesions will involute over time. Primary clinicians have a key role in informing and reassuring patients and their parents about the benign nature of OH and maintaining regular follow-ups for monitoring. If medical therapy is initiated, patients need to be monitored regularly for side effects. If sclerotherapy or surgical resection is required, interventional radiologists or oral and maxillofacial surgeons, respectively, will be involved to assess patients as surgical candidates.