Sclerotherapy of benign oral vascular lesion with ethanolamine oleate: An open clinical trial with 30 lesions

doi:10.1016/j.tripleo.2004.12.021

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 100, Issue 5, November 2005, Pages 579-584

https://doi.org/10.1016/j.tripleo.2004.12.021 Get rights and content

Objective

The objective of this study was to report and discuss the results from treatment of benign oral vascular lesions with ethanolamine oleate.

Study design

Twenty-seven patients with 30 examples of oral vascular malformation, hemangioma, or varix were treated with intralesional injections of 1.25% or 2.5% ethanolamine oleate at an interval of 15 days between each application. The lesions were divided into 2 categories: (1) lesions of 20 mm or less and (2) those greater than 20 mm. Subsequently, the Mann-Whitney test was used a means of statistical analysis.

Results

Although the number of injections varied from patient to patient, all lesions responded to the treatment, showing total clinical regression. Lesions of 20 mm or less needed a lesser number of applications than those greater than 20 mm (P < .05).

Conclusions

Ethanolamine oleate is a 100% effective sclerosant agent for treatment of benign oral vascular lesions. In this study, no difference was found between the 2 concentrations applied.

Section snippets

Study design

An open clinical trial of 27 patients with 30 examples of oral vascular malformation, hemangioma, or varix were treated with intralesional injections of 1 mL of 1.25% or 2.5% EO. A 15-day interval between each application was applied, until the total clinical resolution of the lesion had occurred. The lesions were then divided into 2 groups: (1) lesions of 20 mm or less, and (2) those of greater than 20 mm. Here, the Mann-Whitney test was used as a means of the statistical analysis.

Results

All 30 lesions responded to the treatment with total clinical resolution. None of the patients showed signs of scarring. After the application of EO, 17 patients complained of pain, swelling, redness, and/or burning regardless of the concentrations. These symptoms were present only up to 72 hours after applications. No information about the symptoms was obtained from the other patients.

The number of applications required for the treatment of all lesions varied from 1 to 10 (mean average of

Discussion

In the present study, the use of 1.25% or 2.5% EO as a choice treatment of benign oral vascular lesions was considered 100% satisfactory. Our patients reported symptoms of pain, swelling, redness, and/or burning after the application of EO, but for only 72 hours. Choi et al¹⁴ also reported similar symptoms. This research, therefore, represents the first large series of cases of benign oral vascular lesions treated with EO. Therefore, 2 concentrations of EO (2.5% or 1.25%) were applied,

References (36)

T. Muto et al.
Therapeutic embolization of oral hemangiomas with absolute ethanol
J Oral Maxillofac Surg
(1990)
L. Van Doorne et al.
Diagnosis and treatment of vascular lesions of the lip
Br J Oral Maxillofac Surg
(2002)
J.O. Meirelles-Santos et al.
Absolute ethanol and 5% ethanolamine oleate are comparable for sclerotherapy of esophageal varices
Gastrointest Endosc
(2000)
M. Hashizume et al.
Haptoglobin to protect against renal damage from ethanolamine oleate sclerosant
Lancet
(1988)
H. Baurmash et al.
The nonsurgical treatment of hemangioma with sotradecol
Oral Surg Oral Med Oral Pathol
(1963)
D. Chin
Treatment of maxillary hemangioma with a sclerosing agent
Oral Surg
(1983)
B. Minkow et al.
Treatment of oral hemangiomas with local sclerosing agents
Int J Oral Surg
(1979)
H. Baurmash et al.
A conservative approach to the management of orofacial vascular lesions in infants and children: report of cases
J Oral Maxillofac Surg
(1991)
J.B. Mulliken et al.
Vascular anomalies
Curr Prob Surg
(2000)
P.C. Salins et al.
Management of large vascular lesions of the lip: case reports
Int J Oral Maxillofac Surg
(1997)

S.J. Fishman et al.

Hemangiomas and vascular malformations of infancy and childhood

Pediatric Surg

(1993)

M.C. Finn et al.

Congenital vascular lesions: clinical application of a new classification

J Pediatr Surg

(1983)

J.B. Mulliken et al.

Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics

Plastic Reconstr Surg

(1982)

I.T. Jackson et al.

Hemangiomas, vascular malformations, and lymphovenous malformations: classification and methods of treatment

Plast Recons Surg

(1993)

B.W. Neville et al.

Oral & maxillofacial pathology

(2002)

R.W. Christeinsen

The treatment of oral hemangiomas: report of four cases

Oral Surg Oral Med Oral Pathol

(1959)

O. Enjolras et al.

The current management of vascular birthmarks

Pediatr Dermatol

(1993)

D.R. Weathers et al.

Trombosed varix of oral cavity

Arch Dermatol

(1971)

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Vascular malformations of the head and neck are common. The management of these lesions is complex and challenging due to the high complication rate and recurrence following treatment. Palatal vascular malformations (PVMs) are infrequent and present as slow growing lesions in the palate with recurrent bleeding and pain. These lesions are best managed by sclerotherapy due to their posterior location and risk of bleeding if surgery is attempted. Many sclerosants have been used for treating PVMs but the use of intralesional bleomycin for these lesions has not been reported at length. This paper describes the use of intralesional bleomycin injections for the treatment of deep-seated palatal vascular malformations.
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Vascular anomalies are common in the head and neck, and oral lesions are most commonly found on the lips, tongue, mucosa, and palate. Monoethanolamine oleate sclerotherapy (MOS) is an option for treatment, although we know of no established protocols yet. We report the prevalence and characteristics of intraoral vascular anomalies (IVA) and the results achieved with the use of 5% MOS, and suggest a clinical guideline. Data from the medical records of patients with IVA were collected (age, sex, ethnicity, site, size, duration, and treatment). Cases treated with MOS were detailed, and data about number of applications, interval between them, dose, adverse effects, and results were recorded. A total of 65 cases of IVA were found. White-skinned women aged from 61 to 70 years (n = 21) were most likely to be affected, and the lower lip (n = 25) was the most common site. Twenty-seven were treated with MOS using a mean of 1–2 applications with a seven-day interval. The mean dose applied was 0.3 ml/section, which was diluted in local anaesthetic in 38 cases. Twenty-two resolved completely. In summary, we found a prevalence of 4.8% of IVA and European women aged 61 to 70 years were most affected. MOS 5% was effective and safe in the treatment of IVA more than 3 cm in size, with minimal morbidity and adverse effects. We therefore suggest a sclerotherapy protocol of 0.3 ml of the drug (undiluted with anaesthetic) for each 1 cm lesion (maximum 3 cm), with weekly revaluations and further applications when necessary within a 14-day period.
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Use of 5% monoethanolamine oleate foam in oral varicose
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The 5% monoethanolamine oleate foam showed to be effective and safety for treatment this case of the oral varicose.
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Citation Excerpt :
In another study, three of 53 cases developed ulceration after the application of 5% EO which, according the authors, healed spontaneously within 5 days (Costa et al., 2011). Systemic complications such as anaphylactic reactions, hemoglobinuria, nerve damage or cardiovascular collapse can be observed in this type of treatment (Johann et al., 2005; Costa et al., 2011; Kaji et al., 2009; Bordas et al., 1989). This study found no local or systemic complications, probably because the OVAs were small and superficial, blood flow was low, and a smaller volume of the drug was used.
To describe the effectiveness and safety of a sclerotherapy protocol with 5% ethanolamine oleate (EO) at 0.1 mL/3 mm for oral vascular anomalies (OVAs). Our hypothesis is that EO applied at a concentration of 5% may decrease the number of sessions necessary for clinical healing.
We describe a cohort of 15 consecutive patients. OVAs <20 mm were included. Clinical data of the OVAs were collected. Descriptive and bivariate statistical analyses were performed.
Fifteen of the 19 OVAs were varicosities and the lower lip was the most affected site (n = 7). The median size was 6 mm, and one session was required in 89.5% of cases for clinical healing within 28 days. The pain/burning score was low (<2) for most lesions (63.1%) and the degree of satisfaction was high (>8) for all OVAs. The number of applications, final volume of drug and time to resolution differed significantly according to the size of the anomaly.
The protocol with 5% EO was shown to be effective and safe to treat OVAs <20 mm, and with a decrease in the number of sessions, volume and time to resolution, without complications and with high patient satisfaction.
Effectiveness and safety of foam sclerotherapy with 5% ethanolamine oleate in the treatment of low-flow venous malformations in the head and neck region: a case series
2018, International Journal of Oral and Maxillofacial Surgery
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Another common complication after treatment is oedema that ranges from mild to moderate. Various studies that have used the liquid form of EO have mentioned this condition7,11. Lindsey et al. drew attention to the location of the VA and stated that the possibility of a large oedema should be considered, including complications such as difficulty breathing, when a VM is present in the tongue29.
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: The authors thank National Council for Scientific and Technological Development (CNPq) and Foundation for Support of Research in Minas Gerais (FAPEMIG) for assistance. Mesquita, Aguiar, and Gomez are research fellows of the CNPq.

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Oral MedicineSclerotherapy of benign oral vascular lesion with ethanolamine oleate: An open clinical trial with 30 lesions

Objective

Study design

Results

Conclusions

Section snippets

Study design

Results

Discussion

J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Gastrointest Endosc

Lancet

Oral Surg Oral Med Oral Pathol

Oral Surg

Int J Oral Surg

J Oral Maxillofac Surg

Curr Prob Surg

Int J Oral Maxillofac Surg

Pediatric Surg

Congenital vascular lesions: clinical application of a new classification

J Pediatr Surg

Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics

Plastic Reconstr Surg

Hemangiomas, vascular malformations, and lymphovenous malformations: classification and methods of treatment

Plast Recons Surg

Oral & maxillofacial pathology

The treatment of oral hemangiomas: report of four cases

Oral Surg Oral Med Oral Pathol

The current management of vascular birthmarks

Pediatr Dermatol

Trombosed varix of oral cavity

Arch Dermatol

Oral Medicine
Sclerotherapy of benign oral vascular lesion with ethanolamine oleate: An open clinical trial with 30 lesions