I. What is hemangioma? Tumors occurring from vascular tissue are called hemangiomas, 80% of which are congenital. Hemangiomas are benign, slow-growing and rarely malignant. Capillary hemangioma: It is a superficial capillary expansion, twisting and winding. Hemangioma is most often seen at birth (about 1/3) or shortly after birth (within 1 month). It originates from residual embryonic angiogenic cells. The histopathologic features of the tumor are the presence of actively proliferating vascular endothelial cells, the phenomenon of angiogenesis, and the accumulation of mast cells. Oral and maxillofacial hemangiomas account for approximately 60% of all hemangiomas in the body, with the majority occurring in the skin and subcutaneous tissue of the face and neck, and a very small number in the oral mucosa. Deep and intra-maxillary hemangiomas are currently considered to be vascular malformations. They can be found at birth as red dots or small erythematous spots on the skin, which gradually grow, deepen in red and become elevated. Capillary hemangiomas often increase in size more rapidly than infants. The boundaries of the tumor are well defined and may recede slightly when pressed and return to red when relaxed. They can be treated by cryotherapy or surgical removal, or by x-ray irradiation. Spongiform hemangioma: It is usually composed of small veins and fatty tissue. It is called spongy hemangioma because of its sponge-like shape and texture. Most of them grow in the subcutaneous tissues, but they can also be found in the muscles, and a few can be found in the bones or internal organs. Subcutaneous cavernous hemangiomas may be slightly elevated, with normal or bruised skin and soft, well-defined masses. Treatment should include early angioplasty. Small cavernous hemangiomas can also be treated with a local injection of a vascular sclerosing agent (e.g., 5% sodium cod liver oil). Strawberry hemangioma is often invisible at birth, and most lesions are found within one month after birth, starting as small red spots that grow rapidly and stop growing around the age of 1 to 2 years in some children, but the probability is low. It is three times more common in females than in males. It is called strawberry hemangioma because it is shaped like a strawberry. Hemangioma is a common benign tumor in pediatric age. About 3/4 of pediatric hemangiomas exist at birth, and the rest appear within 1 year of age, and are more common in female than male infants. Diagnosis of hemangioma: The diagnosis of vascular or vascular malformation is not difficult, and the position of deeper hemangioma or vascular malformation should be determined by body movement experiment and puncture. 1.Characteristic appearance of the tumor (wine-spotted or prune-like, etc.). 2.Discoloration or shrinkage by pressure. 3.Positive posture test, venous stone on palpation, coagulated whole blood on puncture (sponge type), pulsating sensation on palpation, wind-like murmur on auscultation, pressure closure of blood supply artery and murmur disappearance (trapezoid type). 4.Angiography shows contrast concentration or vascular malformation in the tumor area. 5.Pathological histological examination to confirm the diagnosis. The harm of hemangioma depends on its growth site, size and tissue composition. If hemangioma grows in the face, it is bound to affect the beauty, and in serious cases, it may deform the five facial features; in the neck and throat, it is easy to break down due to feeding, which may endanger the patient’s life; in the functional parts, such as eyes, tongue, fingers, toes, limbs and joints, it may affect the functions of these parts. If the hemangioma is huge, it will seriously endanger the patient’s health no matter what part of the body it grows on. In addition, hemangioma can also become infected, ulcerated, bleeding or even malignant, all of which can seriously endanger the patient’s life. Treatment of hemangioma 1.Surgical treatment: Surgical methods are used to remove the diseased tissue to achieve the purpose of treatment. It works well for independent and small lesions, and is still the preferred treatment for hemangioma. However, sometimes the area occupied by hemangioma is too large to be completely removed surgically, and it is easy to recur after surgery. In addition, surgery is affected by the patient’s general condition, for example, infants and children and patients with poor general condition are not suitable for surgical treatment. 2.Cryotherapy: This method is used for hemangioma treatment from the 1960s (small superficial lesions can be used as appropriate), the operator uses the strong low temperature (-96℃) caused by the volatilization of liquid nitrogen, usually below -20℃, to condense the skin, hemangioma and the tissue around the hemangioma in the lesion area, so that ice crystals are formed in the cells, which leads to cell rupture, disintegration and death, and then the repair process of the body makes the hemangioma disappear. The hemangioma will disappear. However, this method can leave local scars and often leaves serious deformities and dysfunction after treatment in the eyes, corners of the mouth, tip of the nose and ears. Due to the difficulty of controlling the intensity and depth of freezing operation, as well as the different resistance of tissues to low temperature, incomplete treatment occurs. Recurrence is higher, and the evaluation of the efficacy is directly affected. In addition, the local scar left behind deformity dysfunction is not the result expected by the patient, but if such conditions do not occur, the treatment is often ineffective. 3.Radiation and isotope therapy: The treatment principle is to use the r-rays produced by radioactive elements to bombard the nucleus of the tissue in the lesion area to make the DNA and RNA chains in it break, terminate the synthesis of nuclear proteins causing cell death and disintegration, and then achieve the treatment purpose through the tissue repair process. The following are commonly used clinically: superficial X-ray irradiation, cobalt 60 local irradiation, strontium 40 film external paste, phosphorus 32 colloid local injection, etc. After treatment, the treated area is left with atrophic scars after radioactive damage and epidermal desquamation. For this kind of atrophic tissue and atrophic scars caused by radiation irradiation, experts recommend surgical excision, otherwise the possibility of cancer cannot be excluded. At present, irradiation therapy has basically been eliminated, but isotope dressing is still used in the treatment of superficial hemangioma in infants and children. 4. Sclerotherapy: This method originates from the 1950s, and is derived from the injection therapy of withered hemorrhoids. The principle is: sclerosis is injected into the hemangioma tumor tissue (cannot be injected into the blood vessels), causing sterile inflammation and local fibrotic reaction after the swelling disappears, resulting in shrinking or occlusion of the hemangioma and vascular cavity. Commonly used drugs include: ① cod liver oil sodium acid; ② kuhelian injection; ③ alum injection; ④ kuhelian yellow lotus injection; ⑤ sodium bicarbonate injection; ⑥ pinyamycin and peleomycin type; ⑦ boiling water injection therapy; ⑧ urea injection. This method is also rarely used at present. 5.Laser treatment: Using professional laser treatment equipment to coagulate the hemangioma tissue and achieve the purpose of treating hemangioma. However, the depth of laser treatment is generally controlled within 0.2~0.4mm of superficial skin, and more than 0.4mm will produce obvious scars, so it has certain effect on superficial capillary hemangioma, but is generally not recommended for deep hemangioma. 6.Photosensitization laser therapy (also called photodynamic laser therapy) is to inject photosensitizer into the patient’s blood vessels first, and then irradiate the hemangioma area with black light or long waveband laser. The photosensitizer activation produces photochemical reaction and leads to photographic process in the endothelium and interstitium of the hemangioma, which causes occlusion of the vascular lumen to achieve the treatment purpose. However, this therapy must be strict in the treatment process, otherwise there will be serious photosensitive endophthalmitis, fibrous tissue disease after photosensitive retinitis. 6.Interventional therapy: It refers to the introduction of arteriovenous catheter into the site of hemangioma under the guidance of “X”, and then injecting embolic agent into the tumor to produce sterile inflammation in order to achieve the effect of occlusion of the tumor vessels. This is commonly used for visceral hemangiomas such as hepatic hemangiomas. For deep hemangiomas of the trunk and limbs, it is often difficult to achieve the desired effect due to the limitation of injection dose and dosage form, as well as the limitation of hemangioma characteristics. The indications for use should be strictly controlled and the flow of embolic agents into other organs and tissues should be avoided.