Central Hemangioma By Catherine DiGregorio Oral Pathology 2017
A central hemangioma is a vascular lesion found within the bone. It is considered a rare condition. They are often difficult to diagnose. Often asymptomatic, many people only come in once swelling caused pain or discomfort or they are detected during a routine dental visit. Central hemangiomas can be difficult to treat, due to vascular nature of the lesion. Extractions in this areas can be problematic. Both clinical and radiographic evidence are necessary to diagnose this lesion, but diagnosis can be difficult and a biopsy can also be problematic. Hemorrhaging is a possibility if precautions are not taken. Etiology The etiology of the central hemangioma is unknown.
Clinical Presentation Clinical presentation of a central hemangioma could be a bluish mass, with or without pulsation. Mobile teeth may be present in this area as well. This area could also discharge blood. Demographic Although the central hemangioma is quite rare, studies show that it mainly occurs in women in a 2:1 ratio. Occurrence is usually in the second decade of life. Central hemangiomas are found to occur more in Caucasians. Biopsy / Histology / Radiographs Biopsy of a central hemangioma can be hazardous or fatal due to the vascular nature of the lesion.
Histologically endothelial cells proliferate and form a pattern of vascular space. Thin wall spaces are lined with single layers of endothelial cells between bony trabeculae. The central hemangioma has three stages. The early stage is highly vascular. The intermediate stage will exhibit some blood clotting and the terminal stage has various degrees of ossification.
Radiographically the central hemangioma can present as many other intrabony lesions. Radiographically the central hemangioma presents as a multilocular radiolucency with fine trabeculation.
Differential Diagnosis A central hemangioma can be mistaken as many different other lesions. A differential diagnosis may include an ameloblastoma, giant cell lesion, myoma, dentigerous cyst, fibrous dysplasia, osteosarcoma, aneurysmal bone cyst, residual cyst, and granuloma. Treatment There are various treatment options for a central hemangioma. Some treatments include non invasive radiotherapy for lesions that are not accessible. Another treatment is intralesional injection of sclerosing agents . An injection can be administered into the lesion of boiling water, sodium morrhuate or sodium tetradecyl sulfate. These injections are usually used in extensive lesions. The agents work as a tissue irritant and thrombogenic agents, but do not work on osseous lesions. Embolization of major vessels supplying blood to the hemangioma is an used when patient is not a good candidate for surgery. Curettage of the lesion along with radiation is suggested to be the best treatment for central hemangiomas. During surgery blood loss is to be expected. Curettage of the lesion is usually followed by bone grafting.
Prognosis Prognosis with treatment is rare recurrence of central hemangioma. Treatment does include risks, such as hemorrhaging. Prognosis without treatment can include mobility of teeth, facial asymmetry, pain, pulsation, supraeruption, early exfoliation or exfoliation of permanent teeth in the area of the central hemangioma have been observed. Swelling can occur and cause pain and paresthesia. Root resorption has also been observed in some patients.
Professional Relevance This lesion is important to understand and recognize as a dental hygienist because we are the first to observe the patient intra orally and possibly to view the radiographs as well. Recognizing pathology is extremely important to ensure the patient receives the treatment they need. Legally we must identify and refer out if needed to treat the pathology. It is our responsibility to thoroughly assess our patients and refer them to necessary specialists.
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