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Oral Hemangiomas

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Diagnostically, oral hemangiomas pose clinical uncertainty to the dental surgeon. Read the article to know its types, features, diagnosis, and treatment.

Medically reviewed by

Dr. Anuthanyaa. R

Published At March 2, 2022
Reviewed AtDecember 20, 2022

What Are Oral Hemangiomas?

Oral hemangiomas (OHs) can usually be called benign tumors that may develop because of endothelial cell proliferation in the oral cavity. These benign tumors are more frequent on the ventral surface of the tongue, in stark contrast to oral vascular malformations. Oral hemangiomas may commonly be discovered during routine dental examination owing to their tendency to bleed after dental procedures or present with spontaneous gingival bleeding. These lesions are more prevalent on the lips with a predisposition in whites with a 3:1 female-to-male predominance. These are particular incidents in:

  • Infants who are born prematurely.

  • Infants of twins or triplets.

  • Infants who have low birth weight (less than 1 kg).

  • Infants who are born to older mothers are all at a likely possibility to develop OHs.

An estimated 60 to 70 percent of hemangiomas occur in the head and neck region. Though comparatively rare in the oral cavity, these lesions involve the lips, tongue, buccal mucosa, and palate in the infants affected. Oral hemangiomas can also be observed in the mandible, maxilla, or intramuscularly within the masseter or other masticatory muscles. Clinically in cases of the intramuscular or even in central hemangiomas occurring in the jaw, gingival bleeding is a very common clinical feature accompanied often by root resorption bony expansion. The patients may present with tooth pain, swelling, or even tooth mobility, and the dentist may observe post-extraction bleeding severity in these individuals.

How Are Oral Hemangiomas Classified?

Clinically, hemangiomas can be classified as:

Infantile Hemangiomas:

Infantile hemangiomas (IHs) usually form during the first 2 months of life. These lesions rapidly proliferate between 6 and 12 months of age. Then they undergo a characteristic period of slow involution. Most IHs will spontaneously fade away between 6 and 9 years of age.

Congenital Hemangiomas:

Congenital hemangiomas (CHs) are present at birth. The majority of hemangiomas will completely involute, with 10 to 20 % lesions that may persist into the early adolescence or puberty phase. These lesions do not exhibit a proliferative phase and can either involute or not undergo this phase at all.

What Is the Broadly Trusted Hypothesis of Oral Hemangioma?

The hypothesis commonly trusted by the research behind OH formation is that they are formed due to embolic placental endothelial cells. These cells enter the fetal circulation after a trauma or in response to a cellular stressor and function as stem cells. Studies also show that chorionic villus sampling during pregnancy increases the risk of hemangiomas in the infant though this theory remains elusive.

Another theory is that loss-of-functional mutations on chromosome 5q can trigger or create activation of angiogenesis phenomenon in the child, resulting in hemangioma formation.

A third and widely accepted hypothesis is that hemangiomas may be formed due to the up regulatory metabolism of vascular endothelial growth factor (VEGF) and glucose transporter 1 (GLUT1) production by the local cells in response to hypoxic stressors.

What Are the Clinical Features of Oral Hemangiomas?

  1. OHs are painless, asymptomatic, soft, and compressible masses found mostly only upon routine clinical examination by the dentist.

  2. These lesions can vary both depending on location and depth.

  3. Superficial lesions show a prominent red hue and can be further clinically described as lobulated, sessile, or pedunculated appearance.

  4. Deeper lesions, though more difficult to visualize, can appear to the dentist as a soft blue or violent discoloration clinically distinct from surrounding mucosa.

  5. Diascopy employs the principle of blanching of an oral lesion following compression with a finger or glass slide.

  6. In this physical examination, a maneuver is used to distinguish or differentiate between the vascular lesions (blanching) from purpura (non-blanching). This can be performed to confirm the diagnosis of OH by the dentist.

  7. The physician or dentist can identify the same by applying pressure on the abdominal region or compressive force on the abdomen while lowering the head on which the OH may turn dark in appearance.

What Are the Differential Diagnosis of Oral Hemangiomas?

The dentist should differentiate between the below-given conditions that may poise similar characteristics to oral hemangiomas but can be ruled out during diagnostics by:

The differential diagnosis of oral hemangiomas are:

How Are Oral Hemangiomas Diagnosed and Treated?

Treatment is mainly diagnostic that can be confirmed by the first-line imaging modality of color Doppler ultrasound. If an intraosseous or intrabony or intramuscular hemangioma is suspected by the physician, a contrast-enhanced MRI (magnetic resonance imaging) would be the imaging modality of choice. Doppler technique is not only cost-effective and non-invasive; it also helps to diagnose without the risk of radiation. It can accurately diagnose in a short time span and provides morphological characteristics. It is preferable to the conventional CT scan.

Most surgeons and physicians prefer steroid therapy and beta-blocker drugs depending upon the lesion's size, location, and extent. Patients, especially children and young infants, should be monitored during the course of steroid therapy (mainline treatment) for the development of:

  • Persistent hyperglycemia.

  • Hypertension.

  • Growth retardation.

  • Mood changes.

For patients with OHs resistant to beta-blockers and steroids, interferon-alpha has been studied but is generally not preferred or used judiciously due to the side effect of liver toxicity in excess doses.

Surgical resection remains the other mainline treatment for OH and may be preferred for smaller lesions located on the lips and buccal mucosa by the dental surgeon. Resection would not be preferred for lesions on the tongue as removal of tissue in the case of large lesions can result in chronic impairment of speech and swallowing. Sclerotherapy, in which a foreign agent (such as 3% sodium tetradecyl sulfate or ethanolamine oleate) is injected into one of the major vessels of an OH. It is an evolving treatment modality preferred by maxillofacial surgeons for these lesions that will obliterate the endothelium and cause shrinkage.


Oral hemangiomas though benign in nature, are a source of oral discomfort. It needs prompt action by the maxillofacial surgeon or dentist to prevent further aggravation either by the required drug therapy, sclerotherapy, or surgical resection.

Frequently Asked Questions


Are Hemangiomas Cancerous or Benign?

Hemangiomas are benign growths of vascular origin. They are an overgrowth of the blood vessels. In extremely rare conditions, they become cancerous. Hemangiomas appear like tangled blood vessels. 


Are Hemangiomas Serious in Nature?

Hemangiomas are mostly harmless in nature. They can be found anywhere in the body and under the skin. Most cases of hemangiomas resolve on their own. They are seen as red or purple lumps on the skin. 


Do Hemangiomas Require Surgery?

Most cases of hemangiomas do not require surgery. It is removed if only it is bothersome to the person. Sometimes, the hemangiomas are removed due to aesthetic reasons. Hemangiomas are removed using laser treatments.


What Are the Common Treatments Methods for Hemangioma?

The common treatment for hemangioma include:
- Treatment with beta-blockers. 
- Treatment using corticosteroids. 
- Treatment with laser surgery. 


What Are the Various Risk Factors for Hemangioma?

The various risk factors for hemangiomas include:
- Females have a greater risk of developing - hemangiomas. 
- Fair skin. 
- Low birth weight. 
- Multiple pregnancies. 
- Premature birth.
- Progesterone treatment. 


Can Hemangiomas Resolve on Their Own?

Yes, many times, the hemangiomas resolve on their own. Hemangiomas are a harmless overgrowth of the blood vessels. They appear as red or purple spots on the skin. Hemangiomas, in many cases, resolve without any treatment. 


Why Do Hemangiomas Occur?

Hemangiomas can occur if the blood vessels are not formed properly. Hemangiomas occur due to the clumping of blood vessels. This is formed due to abnormal growth of cells of blood vessels in one area. 


What Causes Hemangiomas in the Mouth?

Oral hemangiomas are benign growth of the blood vessels of the mouth. They occur when the cells of the blood vessels grow excessively. They are usually harmless and occur in the lips, cheek, and tongue.


How to Stop the Growth of a Hemangioma?

The growth of hemangioma can be stopped with a few medicines that are available. Propranolol is one medicine prescribed to stop the growth of a hemangioma. This medication causes the hemangioma to shrink. 


Are Biopsy Required to Treat Hemangiomas?

Hemangiomas are harmless growth of the cells of blood vessels. In the majority of cases, hemangiomas do not require a biopsy. A biopsy may be required in only those cases that require a differential diagnosis for other conditions.


How Does a Cancerous Hemangioma Look Like?

A hemangioma that turns cancerous looks like a tumor overgrowth. It seems like a big red growth under the skin. The blood vessels are visible. It feels like a rubbery overgrowth of the blood vessels. 


Can Hemangiomas Cause Pain?

Hemangiomas are usually asymptomatic. They do not cause pain. However, they can be seen as red or purple spots under the skin. Hemangiomas, when painful, can become a cause of concern. The doctor may consider running a few tests when these growths become painful.
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Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop



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