Clinical manifestations of oral and maxillofacial hemangiomas and vascular malformations

  Hemangioma: Strawberry-shaped, protruding from the skin, uneven in height, visible at birth. It is composed of a large number of intricately intertwined capillaries with small lumens and occurs mainly in the skin of the maxillofacial region; it is rare in the mucosa. The biological behavior of hemangioma is that it can spontaneously regress, and its course can be divided into proliferative, regressive and regressive completion phases. Generally, the proliferative phase occurs 4 weeks and 4-5 months after birth, and the growth stops around 8-12 months, followed by the degenerative phase, with a regression rate of up to 98% and half of them regressing within 5 years of age. The clinical manifestation is that the tumor changes its color from bright red to dark red, light red, or even grayish white, and the tension of the tumor body decreases and becomes soft, shrinks, and flattens. It is believed that the natural regression rate of hemangioma within 3 years of age is 50%~60%, and after 5 years of age, the tumor enters the completion stage of degeneration and the local skin returns to normal, and individual cases may have skin laxity, scarring or atrophy.  Vascular malformation: It is mainly formed by the combination of venous origin or micro-vein, artery and lymphatic vessels, and consists of blood sinuses of different sizes.  Midline microvenous malformation (salmon spot): located in the midline area of the neck is common, but can also be located in the forehead or between the eyebrows or in the middle of the person. They appear as pale pinkish-red spots, which may fuse and are well defined.  Microvenous malformation (wine-colored spot): Mostly occurs in the head and neck, often distributed along the trigeminal nerve, the lesion is flat with the skin surface, clear circumference, pink or bright red, varying in size, and the color can be restored by finger pressure. It may gradually increase in size and not fade away.  Venous malformations (cavernous hemangiomas): They are found on the face of the mouth such as cheeks, neck, eyelids, lips, tongue, floor of the mouth, parotid glands and neck. They are usually subcutaneous or submucosal, pale or purple in color, with normal skin and mucosal color and unclear boundaries.  Gingival bleeding is a common symptom, and tooth extraction can cause a jet-like hemorrhage, or sudden hemorrhage that can be life-threatening. In a few cases, the diagnosis is difficult when there is only swelling of the jaw bone without bleeding symptoms, and it should be differentiated from jaw bone cysts, etc. X-ray is a sparse area of bone with unclear borders, a honeycomb or soap bubble-like translucent area or a hyperplastic reaction of bone trabeculae, a sunlight-responsive spot or a brush-like hyperdensity shadow.  Arteriovenous malformation (trapezoid hemangioma, also known as grape hemangioma): It is a kind of tortuous, irregular and pulsating hemangioma, mainly formed by direct anastomosis between arteries and veins with significantly dilated vessel walls, so it is also called congenital arteriovenous malformation. It is common in adults and occurs in temporal or subscalp tissues in the distribution range of superficial temporal arteries, with unchanged or erythematous skin color.  The imaging features: contrast radiographs show a well-defined lesion with high-density multilobular parenchymal shadowing with corresponding size of trophoblastic and draining vessels.  CT shows clear lesion boundaries and contrast enhancement, which has differential diagnostic value for bone damage.  MR is valuable for understanding the size of the hemangioma site and the adjacent relationship.  DSA and color Doppler can better understand the hemodynamic pattern of tumor.  Color Doppler examination can understand the size of the lesion and the number of vascular components, and has a high reference value for the evaluation of the treatment effect.