Overcoming A Challenging Case of Massive Hemangioma of The Tongue
A 23-year-old male, a unique case presented at our Richardson Hospital burdened by a large tongue lesion diagnosed as a Hemangioma. He presented with a huge swelling of the tongue extending from the anterior 2/3rd of the tongue as well as the posterior third reaching till the base of the tongue and also the floor of the mouth. According to the patient, the swelling was present since birth and gradually increased to the present size.
Despite seeking medical interventions at multiple hospitals and undergoing injectional sclerotherapy treatments, the lesion persisted, causing severe discomfort, speech impediments, and swallowing difficulties. Frustrated and hindered in both professional and social spheres, the patient sought to consult at Richardson’s Hospital. The large tongue was creating cosmetics as well as functional impairements.
Diagnostic Insights
Upon initial consultation with Dr. Richardson, he meticulously examined the extensive tongue lesion, suspecting an arteriovenous malformation (AVM) due to its large size, raised, beaded bluish-purple discoloration, pulsatile nature and irregular borders and clinical features. The patient underwent MR Angiography and routine blood investigations to unravel the complexities. Considering the risk of bleeding associated with AV malformations, blood was arranged, and a comprehensive plan was devised. MR Angiography was specially advised in this case which provided detailed images, helping to identify the extent and nature of the vascular malformation and the feeding blood vessels.
Also, the patient was informed about the necessity of embolization a pre-surgical procedure involving the occlusion of feeding vessels to reduce blood flow to the tumor.
Surgical Execution
On the day of surgery, the procedure was done under general anaesthesia. The entire massive Hemangioma lesion was removed in toto. Under general anesthesia, electrocautery was employed to minimize intraoperative bleeding. Measures like hypotensive anesthesia were adopted to further minimize the bleeding risks. The meticulous excision aimed to prevent recurrence, ensuring a thorough resolution of the patient’s concerns. The tongue was brought back to its original contour and shape and closure was done using resorbable sutures.
Post-Surgical Recovery
Post-surgery, the patient experienced a remarkable transformation. A ten-day hospital stay for healing gave him the restoration of both cosmetic appearance and functionality. The surgery acted as a miraculous turning point for the patient, who could now speak and swallow without the hindrance that had plagued him for years.
Long Term Follow-up
A year post-surgery, the patient remains in touch with Richardson Hospital as a testament to the successful outcome. There has been no recurrence seen. He is satisfied with the choices he made and by outcomes he got. The restoration of normalcy has not only improved his physical health but has also significantly enhanced his quality of life.
All You Need To Know
What Is Hemangioma of Tongue?
In simple terms, a hemangioma of the tongue is a type of growth or lump that occurs on the tongue due to an abnormal collection of blood vessels.
These growths are generally non-cancerous and can vary in size. They might appear as a red or purple bump on the tongue. While some hemangiomas cause no trouble, others might lead to discomfort, difficulty in speaking, or problems with swallowing, especially if they become large.
Choice of Treatment
Sclerotherapy
Typically for small-sized lesions management involves injecting a solution-sclerosing agent directly into the blood vessels of the hemangioma/tumor to shrink and seal them.
Laser Therapy
Laser treatment can be effective for smaller hemangiomas, especially those near the surface of the skin. The laser helps reduce the visibility of the blood vessels, improving the appearance of the hemangioma.
Medications (Beta- Blockers)
For rapidly growing or problematic hemangiomas, medications like beta-blockers (e.g., propranolol) may be prescribed as an adjunctive treatment. These medications can help slow down the growth of the hemangioma and, in some cases, shrink it.
Surgical Excision- Large massive or problematic hemangiomas may require surgical removal. Surgery is carefully planned to minimize scarring and ensure complete removal of the growth. The recurrence rate is very minimal with the excision as compared to other treatments.