INTRODUCTION
Hemangiomas are common congenital head and neck anomalies characterized by rapidly proliferating endothelial cells that line blood-filled spaces, having an incidence of 3% to 10% at 1 year of age but disappear completely by 5 years of age in about 50 to 80% of cases.1,2 While 60 to 70% of hemangiomas are found within the head and neck region, oral hemangiomas are rare, frequently involving the tongue, lips, buccal mucosa, palatal mucosa and jaw bones. They appear as a stain or nodule that is either smooth, lobulated, sessile or pedunculated that varies from deep red to a purple colour depending on its size and depth in tissue.3,4,5 The condition is more frequent among premature-low-birth-weight infants, gestational hypertension, twins and affects females three times more than males. The International Society for the Study of Vascular Anomalies (ISSVA) classifies these as benign vascular tumors either of the infantile or congenital variety based on time of presentation and behavior of the lesion.6
Hemangiomas of the tongue usually present as small lesions less than 3-5 cm in size. However, giant lingual hemangiomas involving up to a half or two thirds of the tongue have been reported previously, posing a significant risk to patient which may considerably deteriorate their quality of life.7,8 It is crucial to note that these reports involved management of hemangiomas in older patients and to the best of our knowledge this is the first report that addresses the surgical management of such a complex case in an infant. Early diagnosis and treatment of such lesions is vital in preventing catastrophic complications such as traumatic hemorrhage, difficulty in breathing, feeding, speech, delay in linguistic development and mandibular dysmorphogenesis.9
Hemangiomas usually do not require any treatment due to their benign nature and high rate of complete involution over time. However, in cases where the lesion fails to involute despite conservative measures or is extremely large and poses an imminent threat to life, surgical intervention may be the only treatment of choice despite the inherent risk of potentially fatal intra-operative hemorrhage.10-13 We therefore aim to describe the successful management of an infant presenting with a massive hemangioma involving two-thirds of the tongue with a potential for fatal complications had surgical intervention not been carried out.