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  1. 1. CPCClinical Case Study II Majd Hasanin
  2. 2. Chief Complaint Patient came for routine check up. Upon examination a painless red lesion was discovered on the tongue.
  3. 3. History• Medical History: – Not Significant.• Dental History: – Multiple restored teeth.
  4. 4. Clinical Examination• Extra-oral Examination revealed: – Lymph nodes and extra-oral structures all appears to be within the normal limit. – No pain, no tenderness present.
  5. 5. Clinical Examination• Intra-oral Examination, revealed: – A reddish-blue macule at the surface of the tongue. – Painless, even upon palpation.
  6. 6. Intra-oral PhotographReddish-blue Macule.
  7. 7. Differential Diagnosis• Mucocele.• Ranula.• Superficial Cyst.• Hemangioma.
  8. 8. Histopathology
  9. 9. Definitive DiagnosisCongenital Cavernous Hemangioma.
  10. 10. Treatment• Sclerosing Technique (sodium tetradecyle sulfate).• Cryosurgery.
  11. 11. Hemangioma
  12. 12. Introduction• A hemangioma is an abnormal buildup of blood vessels in the skin or internal organs.• It may be congenital or traumatic in origin.• It is called vascular nevus• composed of seemingly disorganized vessels that are filled with blood and is connected to the main vein
  13. 13. Types• Central – In bone• Capillary – Intercommunication capillary vessels • Strawberry angioma • Port wine stain • Salmon’s notch• Cavernous – Dilated blood containing spaces lined by endothelium• Arterial
  14. 14. Introduction, cont.• Etiology: Congenital.• Incidence: About 30% of hemangiomas are present at birth. The rest appear in the first several months of life• Gender: female to male ratio is 2:1• Age: 1st and 3rd decades.• Site: most common site are the lips, tongue, buccal mucosa and palate
  15. 15. Clinical Features• Appear as a flat or raised lesion of the mucosa• Deep red or blue reddish in color and seldom is well circumscribed• May vary in size and may become larger on physical activities• Some lesions are pedunculated and globular and some are broad based and flat or slightly raised
  16. 16. Clinical Features• Compressibility test, continue pressure will push blood out of the lesion.• If associated with tongue it may cause loss of mobility.
  17. 17. Hemangioma
  18. 18. Complications• Bleeding (especially if the hemangioma is injured).• Problems with breathing and eating.• Psychological problems, from skin appearance.• Secondary infections and sores.• Visible changes in the skin.• Vision problems.
  19. 19. Management• Usually regress by itself during adolescent period.• Laser surgery, cryosurgery by dry ice.• Sclerosing technique.• Injection of boiling water or hypertonic saline.• Radiation therapy.• Corticosteroids.
  20. 20. Thank You all for your kind attention
  21. 21. References:• Habif TP. Vascular tumors and malformations. In: Habif TP, ed. Clinical Dermatology. 5th ed. St. Louis, Mo: Mosby Elsevier; 2009:chap 23.• Textbook of oral medicine, AnilGovindrao Ghom For: White and Pharoah