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.