(68) Use of Sclerotherapy in the Treatment of Intranasal Hemangiomas: Case Report and Review of the Literature

Abstract: Facial hemangiomas can present significant treatment challenges due to their vascularity and the associated risks of necrosis or excessive bleeding with conventional interventions such as surgical excision or interventional radiology. Treatment options for hemangiomas and vascular malformations (VMs) include surgical excision, laser therapy, use of sclerosing agents, and/or embolization. However, approaches are often limited by lesion size, location, and risk of complications. Sclerotherapy is a minimally invasive treatment that involves injecting a sclerosing agent into the lesion to induce endothelial damage, vessel thrombosis, and subsequent fibrosis. Different sclerosing agents are used depending on the type and location of the vascular malformation. Sodium morrhuate, an anionic surfactant, has been shown to be effective in treating vascular malformations, particularly those with high-flow components (Li et al, 2017). Ethanol, ethanolamine oleate, and pingyangmycin are commonly used sclerosing agents that have demonstrated a higher likelihood of inducing complete or partial resolution of VMs. However, this efficacy comes at the cost of increased risk of permanent morbidity, including nerve damage, tissue necrosis, and other local complications (De Maria et al, 2020). Polidocanol is often preferred for smaller, superficial lesions due to its milder effects, while bleomycin is used for slow-flow vascular malformations with a favorable safety profile.

This case report describes a 52-year-old female with a nasal hemangioma severe enough to obstruct her right nostril. Despite experiencing significant psychological distress and social withdrawal due to the lesion’s appearance, she had been denied multiple treatment options. Given the absence of bleeding episodes and a patent left nare, prior providers advised against intervention. However, the lesion continued to impact her quality of life. Upon evaluation, she was offered sclerotherapy—an option not previously considered in her case. She underwent three sessions of 0.25 mL of 5% sodium morrhuate injections over a two-month period. The lesion gradually sclerosed, leading to significant cosmetic improvement and restored nasal patency without complications such as necrosis or scarring. The patient reported a significant enhancement in her quality of life, with increased confidence in social and professional settings. Prior literature has demonstrated the efficacy of sclerosing agents in managing hemangiomas, with studies showing that sodium morrhuate effectively induces endothelial damage and vessel occlusion, leading to lesion regression (Li et al, 2017). Additionally, case reports have highlighted the successful use of sclerotherapy for hemangiomas as a minimally invasive alternative when other treatment options pose high risks (Parvathidevi et al, 2013). This case highlights the potential of sclerotherapy as a safe and effective alternative for nasal hemangiomas in the oral and maxillofacial office setting, especially in patients who have been denied conventional treatment options.

References
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Photo after sclerotherapy treatment Photo before sclerotherapy treatment