Spongiform hemangiomas are vascular malformations with low blood flow that appear at birth, also known as venous malformations. The vascular damage generally develops slowly, often increasing in size during childhood or adolescence, and increasing insignificantly in adulthood. Most venous malformations are spongy in shape, hence the name. In addition to the skin and subcutaneous tissues, lesions can also occur in the submucosa, muscles, and even bones. There are many reports in the literature of severe or fatal bleeding during resection of cavernous hemangiomas in the bone, especially in the mandible, if they break down due to trauma or secondary infection. Previously, cavernous hemangioma was included in the literature as a hemangioma. Mulliken classified hemangiomas into two categories, hemangiomas and vascular malformations, based on the histological characteristics of vascular endothelial cells, and vascular malformations were divided into low-flow vascular malformations and high-flow vascular malformations. Spongiform hemangioma is a venous malformation among the low-flow vascular malformations. Clinical manifestations: In superficial cavernous hemangioma, the skin is inflated and undulating, and the skin surface is slightly blue or light purple, and the varicose and coiled blood vessels are faintly visible. If the spongiotic hemangioma is deeper and does not affect the skin, there is no obvious change in skin color except for mild to moderate localized irregularities. Spongiform hemangiomas can also be seen in the submucosa, with dark blue changes on the mucosal surface. The swelling is compressive and its size may change with body position. On palpation, there is a sensation of coiled worms, or granular venous stones may be found, and radiographs may also show venous stones, which are formed by thrombotic calcium salt deposits. Spongiform hemangioma is usually found on the head, face and neck, followed by the extremities and trunk. In addition to the subcutaneous tissue of the skin, they are occasionally found in the submucosa and can also occur in the muscles, bones, and internal organs. Most of them are found at birth, or the onset of the disease is so insidious that it is difficult to trace the exact date of onset. Spongiform hemangioma can also occur in muscle tissue and is called intermuscular hemangioma, with the quadriceps muscle being the most commonly involved and easily misdiagnosed; sometimes it involves bone and has a rough and uneven surface, like a bug bite. Although the incidence of cavernous hemangioma in the maxilla and mandible is not high, it should be taken seriously, and sometimes the extraction of a loose tooth can lead to fatal hemorrhage. When a hemangioma is irritated, it may cause an inflammatory reaction in the perivascular tissue, and the patient may feel warmth, swelling, and pain in the skin, or it may break down on the surface of the lesion. When there is thrombosis or vein stone formation, local pain may also occur. The pain is often transient, short for a day or long for several weeks, and later relieves itself. The pain is often transient, lasting from one day to several weeks, and resolves on its own. In cases of trauma or surface rupture and infection, the risk of bleeding can arise. Most cavernous hemangiomas are confined; a few diffusely involve large areas of tissue, such as those of the extremities, and are difficult to treat. The diagnosis of adult cavernous hemangioma is more definitive and can be detected from infancy to adolescence, with most exhibiting a more stable and slow progression. The nature of cavernous hemangioma remains controversial, and recent studies have increasingly favored its nature as a congenital vascular malformation, so that the aberrant vascular structure with abnormal hemodynamics could explain many phenomena, including infiltration of the bone. However, this conclusion is inconsistent with many traditional observations and therefore has not yet reached a consensus among different disciplines. In contrast, cavernous hemangiomas in infants and children are more complex, with some growing rapidly in the short term after birth and being effective to hormonal therapy, as well as cases of spontaneous regression; others are detected at birth and persist more steadily into adulthood and are ineffective even with early hormonal therapy. Therefore, it may be difficult to explain these different characteristics of cavernous hemangiomas using morphology as a classification criterion, that is, there are some cases of cavernous hemangiomas in infants and children that are vascular malformations in nature, while others are deep skin hemangiomas. Among infantile hemangiomas, capillary cavernous hemangioma is the second most common type after strawberry hemangioma and is also known as mixed hemangioma. It is generally considered to be a mixture of strawberry capillary hemangioma and cavernous hemangioma and is often detected at birth and grows rapidly in the following months; sometimes it first presents as a strawberry hemangioma and later expands more rapidly into a deep dermal or subcutaneous mass, or vice versa in some cases. A few of them grow particularly rapidly and easily invade the surrounding normal tissues, resulting in serious consequences such as disfigurement, interfering with eating and breathing, or organ displacement, obstruction or even damage, which are called infantile fatal hemangiomas or severe hemangiomas. Pathological observation of mixed hemangioma confirms that the so-called two vascular components are very difficult to distinguish, and the pathological features of capillary hemangioma predominate. Its natural course is also similar to that of strawberry hemangioma, with a tendency to regress spontaneously, effective to hormonal therapy, and the regression is sometimes incomplete, replaced by fatty and fibrous tissue. In addition to the relatively common Klippel-Trenaunay syndrome and Parkes-Weber syndrome mentioned above, there are two rare syndromes associated with cavernous hemangioma. One is Maffucci syndrome, a congenital developmental malformation involving cartilage and blood vessels, which often presents as multiple cavernous hemangiomas with osteochondromas on the end of one limb, such as the phalanges and metatarsals; Jaffe’s statistics suggest that 50% of these patients will develop chondrosarcoma. Another type of nevus is the Blue ubber-bleb Nevus. This is a rare syndrome of cutaneous and intestinal hemangiomas that is autosomal dominant. The spongy hemangioma is present at birth, and later increases in size and size to a distinctive shape of a raised middle rubber nipple with a dark blue center and soft texture. Sometimes the gastrointestinal tract, especially the small intestine, can be widely involved, and when it ruptures, it causes black stool and anemia, and even involves the liver, spleen, pleura and other internal organs and the central nervous system. The diagnosis is usually easy to make based on the history of onset and clinical features: (1) the disease appears at birth and increases with age; (2) the skin surface is elevated or slightly elevated, blue or purplish-red; it shrinks when pressed and returns to its original state after removal of pressure; (3) there are no conscious symptoms, and it usually occurs on the face, neck and head; (4) the histopathology reveals large thin-walled blood cavities composed of tiny veins of different sizes that anastomose with each other (4) Histopathology reveals large thin-walled blood lumens with anastomoses and tiny veins of different sizes, sometimes with thrombosis, mechanization and calcification. There is no abnormal proliferation of vascular endothelial cells. The treatment method of spongy hemangioma can occur in any part of the body, including viscera, and has the characteristics of both expansion and infiltration growth, which can both disfigure and cause dysfunction of organs. 1.Local injection of sclerosing agent. Commonly used sclerosing agents such as sodium cod liver oil acid, urea, pinyamycin and other chemotherapeutic drugs, and hypertonic sodium chloride, Chinese medicinal preparations, etc., have similar results. The treatment is easy to operate, the equipment requirements are low, so it is very widely used. Sclerotherapy requires patient observation and long-term persistence, and it is difficult to achieve ideal and lasting results in the short term, and may even last for life. For the very superficial lesions should be particularly careful, such as the injection volume is too large, may lead to local skin necrosis and scar formation. After sclerotherapy is injected into the tumor, it induces endovascular inflammation, which leads to lumen occlusion and tumor shrinkage or regression. It is commonly used in the treatment of small and medium-sized cavernous hemangiomas. The sclerosing agent should be injected directly into the tumor or its base, not too shallow to avoid surface skin necrosis, and not into the adjacent muscle tissue by mistake, resulting in muscle atrophy, stiffness, so that its function is affected. 2.Copper needle placement After the copper needle is placed into the tumor, the solid component of the blood will agglomerate around the copper needle to induce thrombus formation, which will occlude the blood sinus and the blood vessels connected with the tumor, and the tumor will subside. The copper needle retention method is safe, less traumatic and inexpensive. For cavernous hemangioma with multiple larger vessels connected to it, the surgery is difficult and the effect is poor, but the treatment with copper needle retention can achieve satisfactory results. 3.Laser treatment Because of the limited penetration depth of laser, it is more effective for those with superficial location and few traffic branches, but less effective for those with deep location and extensive traffic branches. The treatment should be equipped with a cooling head. 4.Surgical treatment For limited hemangioma, it is safe to remove and the effect is ideal. For larger or estimated deeper hemangiomas, surgical radical treatment is sometimes possible after preoperative venography, ultrasound and magnetic resonance examination to fully understand the distribution and hemodynamics of the lesion, accurately estimate the amount of blood loss and determine the method of supplementation. For some cavernous hemangiomas of great extent and deeper sites, partial or majority resection can also be considered, to be combined with other treatments after surgery, sometimes with more satisfactory results, and the trauma can be repaired with skin graft or flap. In cases with obvious postural or compression tests, suggesting a larger diameter of the blood sinus, especially in maxillofacial cases with large and deep lesions, simple excision may lead to hemorrhage, so necessary preparations should be made before surgery, such as copper needle treatment, to make the blood in the lesion coagulate before surgery. In order to reduce intraoperative bleeding, non-surgical methods such as sclerotherapy or copper needle placement can be used to reduce the size of the tumor before surgery in cases with large cavernous hemangioma. 5.Other For some stable cavernous hemangioma, and the symptoms and the impact on the appearance are not significant, we can follow up without treatment. In cavernous hemangiomas with extensive involvement of the limb, improvement is often difficult through repeated local excision, and even compensatory expansion of the surrounding malformed vascular network may recur after the hemodynamic equilibrium is disrupted. In such cases, compression therapy, i.e., long-term compression with elastic bandages wrapped from the foot to the root of the thigh, may be used palliatively to retard further expansion and alleviate symptoms to some extent. Prognosis Spongiform hemangiomas present both cosmetic problems and those located in the eyelids, lips, tongue, and nasopharynx can also lead to corresponding dysfunction of vision, speech, swallowing, and breathing. There is a risk of serious bleeding when cavernous hemangiomas break down due to trauma or secondary infection. A small number of cavernous hemangiomas can become malignant and develop into hemangiosarcoma. Therefore, cavernous hemangioma should be treated actively. Chinese herbal medicine Tang Ying treated 17 cases of cavernous hemangioma with abortive tumor easy. The herbs include 30g of Radix Salviae Miltiorrhiza, 12g of Curcuma longa, 10g of Radix Angelicae Sinensis, 12g of Artemisiae Sinensis, 10g of Saffron, 10g of Radix Aromaticus, 10g of Boswelliae Sinensis and Myrrh, 3Og of Semen Sanguinariae, 30g of Rhizoma Alba, and 10g of Scutellariae Sinensis, with decreases according to the predilection of Qi deficiency, dullness and phlegm. One dose of decoction was taken daily and 2 leech capsules were swallowed at the same time, once in the morning and once in the evening. The effective rate of healing was 82.4%. Treatment methods of spongiform hemangioma 1.Surgical treatment, all of them can be removed if they are limited, and some of them can be removed if they are extensive; 2.Microwave heat-transfer therapy, mainly used for spongiform type; 3.Radiation therapy, used for infant capillary hemangioma and superficial spongiform hemangioma; 4.Sclerotherapy, used for spongiform hemangioma; 5.Freezing therapy, used for prune-like and spongiform hemangioma; 6.Hormone therapy, used for infantile hemangioma; 7.Endovascular embolization for trabecular and giant cavernous hemangioma.