Summary
Infantile cavernous hemangioma is a benign vascular tumor in childhood. Cavernous hemangiomas have a tendency of slow enlargement with subsequent complications such as ulceration and bleeding. We report a case of a large cavernous hemangioma affecting the median upper lip in an 11-year-old girl. The lesion was growing and painful on pressure. The patient felt stigmatized. Treatment was wished for by patient and parents. After careful examination including Doppler ultrasound, we suggested a combined approach. In the first step the lesion was coagulated with an intralesional neodymium-YAG laser using a blunt tip. In the second step, immediately after the action of the laser, the lesion was removed completely by surgery. Defect closure was realized with bilateral tissue-expanding vermillion myocutaneous flaps. The patient was followed-up to 5 months. Disfigurement and functional impairment were eliminated. The result was satisfying for both patient and parents. Vascular lesions of the upper lip—particularly when close to Cupid’s bow—can become disfiguring and cause functional impairment. We propose a combined approach with intralesional neodymium-YAG laser photocoagulation to avoid bleeding and to shrink the lesion before complete surgical removal. For defect closure, bilateral tissue-expanding vermillion myocutaneous flaps (Goldstein technique modified by Sawada) were used.
Zusammenfassung
Infantile kavernöse Hämangiome sind benigne vaskuläre Tumoren des Kindesalters. Kavernöse Hämangiome haben die Neigung zu einer langsamen Größenzunahme mit nachfolgenden Komplikationen wie Ulzeration und Blutung. Die Autoren berichten über ein großes kavernöses Hämangiom der medianen Oberlippe bei einem 11-jährigen Mädchen. Die Läsion vergrößerte sich, und es bestand Druckschmerzhaftigkeit. Das Kind fühlte sich hierdurch stigmatisiert. Die Eltern und das Mädchen wünschten eine Behandlung. Nach sorgfältiger Untersuchung der Läsion einschließlich Doppler-Sonographie schlugen die Autoren ein kombiniertes Vorgehen vor. Im ersten Schritt wurde das Hämangiom intraläsional mit dem Neodym-YAG-Laser koaguliert. Im zweiten Schritt, unmittelbar nach Laserung, erfolgte die Komplettexzision. Der Defekt wurde mit einem bilateralen myokutanen Lappen verschlossen. Die Patientin wurde über 5 Monate nachuntersucht. Entstellung und funktionelle Probleme wurden vollständig beseitigt. Mit dem Therapieergebnis waren die Patientin und ihre Eltern zufrieden. Vaskuläre Läsionen der Oberlippe können entstellen und funktionell stören, insbesondere in der Region des Cupido-Bogens. Die Autoren empfehlen eine kombinierte Behandlung mit intraläsionalem Neodym-YAG-Laser zur Photokoagulation, wodurch Blutungen vermieden werden. Die Läsion schrumpft. Der entstandene Defekt nach Komplettexzision kann mit einem bilateralen myokutanen Lappen (Goldstein-Technik, modifiziert nach Sawada) verschlossen werden.
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A. Goldman: conceptualization, visualization, writing—original draft preparation, methodology, investigation, data procession, supervision, writing—review and editing; U. Wollina: conceptualization, visualization, writing—original draft preparation, methodology, investigation, data procession, supervision, writing—review and editing. All authors have read and agreed to the published version of the manuscript.
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A. Goldman and U. Wollina declare that they have no competing interests.
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The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee at Hospital São Lucas da PUCRS, Porto Alegre, Brazil. The patient and parents provided an informed consent statement.
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Goldman, A., Wollina, U. Cavernous hemangioma of the lip: combined treatment with intralesional laser and surgery. Wien Med Wochenschr (2023). https://doi.org/10.1007/s10354-023-01028-2
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DOI: https://doi.org/10.1007/s10354-023-01028-2
Keywords
- Vascular tumors
- Upper lip
- Intralesional laser
- Photocoagulation
- Neodymium-YAG laser
- Bilateral myocutaneous flap