21 Red and purple lesions: Angiomas

Vascular anomalies of the head and neck, sometimes termed angiomas, are divided into two main categories: Vascular malformations (capillary, venous, lymphatic, and arteriovenous malformations (AVM)) and vascular tumors (hemangioma, kaposiform hemangioendothelioma, and tufted angioma).

(See http://emedicine.medscape.com/article/846692-overview.)

Hemangioma

Definition: A reddish, bluish or purplish soft vascular lesion which blanches on pressure.

Prevalence (approximate): 5 in 1000 adults (extraoral angiomas are seen in 2% of newborns).

Age mainly affected: From childhood.

Gender mainly affected: M > F (2:1).

Etiopathogenesis: Hemangiomas in children are usually benign lesions of developmental origin – hamartomas. In adults they differ; they are usually vascular anomalies.

Diagnostic features

History

Oral: Many hemangiomas appear in infancy, most by the age of two years, grow slowly and, by age ten, the majority have involuted (resolved). In adults, hemangiomas rarely involute spontaneously; rather they typically slowly enlarge.

Clinical features

Oral: Most common on the tongue, buccal mucosa or lip, as painless reddish, bluish or purplish soft lesions (Figure 21.1). Hemangiomas usually blanch on pressure, are fluctuant to palpation, are level with the mucosa or have a lobulated or raised surface. Hemangiomas are at risk from trauma and prone to excessive bleeding if damaged (e.g. during tooth extraction). Occasionally, oral hemangiomas develop phlebolithiasis.

Extraoral: Hemangiomas are typically seen in isolation but a few may/>

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