Hemangioma is the most common type of vascular malformation, also known as a birthmark. It is a benign tumor that originates from residual embryonic angiogenic cells. It is most often seen in infants at birth or shortly after birth. Its origin is unknown, and some scholars report that it is related to vascular endothelial stem cells. Hemangiomas occurring in the oral and maxillofacial region account for 60% of the hemangiomas in the body, most of which occur in the facial skin, subcutaneous tissues and oral mucosa, such as the tongue, lips, and floor of the mouth, and a few occur in the jawbone or deep tissues. Causes of disease Hemangioma is the most common benign tumor in infants, with an incidence of about 4-10%, usually more common in girls, about 3-5 times that of boys. It occurs more frequently in whites than in yellows and is less common in blacks. Premature low birth weight (birth weight less than 1 kg) occurs in up to 25% of children, while the incidence of twins is also higher. About 1/3 of all hemangiomas are detected at birth. The average time of appearance of hemangiomas is usually when the infant is two weeks old, and deep hemangiomas may not be detected until 3 to 4 months of age. Adults rarely develop hemangiomas. About 60% of hemangiomas occur in the head and neck, about 25% in the trunk, and about 15% in the extremities. The vast majority (about 80%) of hemangiomas occur in a single location, and a few can occur in multiple locations. Although most hemangiomas occur on the surface of the body, a small percentage can occur in the liver, gastrointestinal tract, or even in the brain. When they first appear, the tumor can be small, partly the size of a pinpoint, and then can expand rapidly. At this time, we call it the rapid proliferation phase of capillary hemangioma. The expansion of the hemangioma will then slow down and usually stop expanding by about 6 months of age. 60-70% of hemangiomas may disappear by the age of 8 years, but some hemangiomas continue to grow and spread rapidly, resulting in changes in appearance and functional impairment, causing psychological disorders and inconvenience in daily life. Although 10% of infants who develop hemangiomas have a family history, it is not a genetic disease. There is no definite food or drug that can cause hemangioma, and there is also no association with maternal behavior during pregnancy. Current research suggests that there may be a relationship with genetic mutations that occur during the transition from progenitor cells to endothelial cells within the fetus. As far as we know, there is no way to prevent hemangiomas. There is no relationship between anything the mother does before or during pregnancy and the development of hemangioma. Appearance of hemangioma Hemangiomas are included in the category of oncology according to their vascular endothelial cell growth characteristics, and are distinguished from vascular malformations such as venous malformations, arteriovenous malformations, and posterior microvenous malformations. The appearance of a hemangioma depends on many factors, including whether it is superficial or deep, whether it is proliferating, stable or receding, and whether it is found at birth or after birth. “The color is usually bright red, similar to that of a strawberry. At the same time, subcutaneous veins can be seen in a radial pattern along the tumor. As the hemangioma fades, its color slowly becomes lighter, usually fading by the time the child reaches 7 years of age. Hemangiomas under the skin are called deep hemangiomas and appear as a bruise or light blue color, some of which are not visible at all. This type of hemangioma is usually not detected until the infant is 2-4 months old. Complications Complications of hemangiomas include ulcers (skin breakdown) leading to bleeding or infection, damage to vital organ function, disfigurement, and, more rarely, heart failure. Ulceration usually occurs in 5-10% of hemangiomas, especially around the lips, anus, or genitals. Local debridement and antibiotics are effective in treating the ulcers, and if bleeding is present, pressure can be applied to the wound to stop the bleeding. Ulcers usually heal within a few weeks and do not recur. However, some may leave scars. If a hemangioma affects breathing, hearing, vision, or eating, you need to see a doctor right away. Diagnosis Most hemangiomas can be diagnosed by physical examination and medical history. Sometimes they need to be differentiated from vascular malformations, including venous malformations and lymphatic malformations, which are treated by different methods. If a mass cannot be diagnosed as a hemangioma or a vascular malformation, color Doppler ultrasonography can be performed to differentiate. CT or MRI can also be performed if necessary. If malignancy is suspected, a puncture biopsy, which is an invasive test, may be required. Treatment The vast majority of hemangiomas do not require treatment other than observation, as they resolve on their own and most resolve completely, with some leaving scars or slight changes in skin color. Some may leave scars or slight changes in skin color. If this is the case, we can treat it with laser or plastic surgery before the child goes to school. Hemangiomas must be treated when: 1) they are growing rapidly; 2) they are large with bleeding, infection and ulcers; 3) they endanger vital functions such as eating, breathing, swallowing, hearing or vision, excretion or motor functions; 4) they are associated with thrombocytopenia syndrome (Kasabach-Merritt syndrome); 5) they are associated with high 6. Lesions invading important facial structures such as eyelids, nose, lips, human middle, earwalls, etc. Treatment methods include drug therapy, surgery or interventional therapy. 1, drug treatment: there are corticosteroids, vincristine, or interferon 2, surgical treatment: the use of surgical methods to remove the damaged tissue to achieve the purpose of treatment. It works well for independent and small lesions. In general, the lesion area is rich in blood vessels and large blood volume, which causes great bleeding during surgery and often causes severe hemorrhagic shock, requiring large amounts of whole blood input during surgery, making the surgery difficult and dangerous. At the same time, the recurrence rate after surgery is very high because all the blood cannot be removed after bleeding and the surgery is terminated. The surgical removal of part of the tumor results in local deformities, defects and dysfunction. Surgery is expensive and unaffordable burden for patients. Facial skin capillary hemangioma can be combined with cosmetic skin grafting to repair the lesion area. Therefore, surgical treatment should strictly grasp the indications and weigh the value of surgery before deciding whether to choose surgical treatment. 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. Also the local scar deficiency deformity dysfunction left is not the result expected by the patient, but if such conditions do not occur, the treatment is often ineffective. Tip: This treatment should be used with caution. Cryosurgery is only useful for superficial hemangiomas and is not effective for deeper hemangiomas. In addition, its biggest drawback is the presence of significant scars after treatment. It is now less commonly used. In the National Conference on Vascular Diseases, experts’ views are basically the same. 4.Radiation and isotope therapy: The treatment principle is to use the r-rays generated by radioactive elements to bombard the nucleus of the tissue in the lesion area to cause the DNA and RNA chains in it to 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. Experts believe that radiation therapy should be avoided during the treatment of hemangioma. Tip: As with cryotherapy, this treatment should be used with caution. Radiation therapy can cause suppression of local development in children and developmental deficits, in addition to significant local hyperpigmentation. Now less used, in the national conference on vascular disease, expert opinion is basically the same. 5, sclerotherapy injection therapy: this method originated in the 1950s, withered hemorrhoid injection therapy derived from. The principle is: sclerosis is injected into the hemangioma tumor tissue (can not be injected into the blood vessels), causing sterile inflammation, swelling disappears after the emergence of local fibrotic reaction, so that the hemangioma, vascular cavity shrinkage or occlusion. Commonly used drugs include: ① cod liver oil sodium acid; ② kuhaolin injection; ③ alum injection; ④ kuhaolin yellow lotus injection; ⑤ sodium bicarbonate injection; ⑥ pinyamycin and pulsatilla class; ⑦ boiling water injection therapy; ⑧ urea injection. 6.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 it is easy to cause bleeding and scar deformity for deep hemangioma. There is also photosensitive laser therapy (also called photodynamic laser therapy), which is to inject photosensitizer into patient’s blood vessels first, and then irradiate the area of hemangioma with black light or long waveband laser. The activation of the photosensitizer produces a photochemical reaction and leads to a photic process in the intima and interstitium of the hemangioma, resulting in occlusion of the vascular lumen for treatment purposes. However, this therapy must be strict in the treatment process, otherwise there will be serious photosensitive endophthalmitis, fibrous tissue disease after photosensitive retinitis. 7.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 because of 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.