Hemangioma of the nasal cavity: A clinicopathologic study
Introduction
Although hemangioma are common lesions of the head and neck, those of the nasal cavity and paranasal sinuses are rare [1]. Some patients can present with severe epistaxis, which often mimics malignancy, often requiring immediate control with ointment gauze packing. Early biopsy for histological confirmation together with computed tomography (CT) scan and MR image are essential to establishing the diagnosis and management planning. We present four cases of patients with a nasal septum hemangioma that originated on the osseous portion and four others on the inferior or middle nasal turbinates. All the tumors were completely removed by the transnasal endoscopic surgery.
There are several methods of treating hemangioma. However, the best method of treatment appears to be wide resection of the tumor. Many surgical approaches were suggested including the natural orifice, transpalatal, transmandibular, lateral rhinotomy. We employ transnasal endoscopic technique for resection of hemangioma.
Section snippets
Materials and methods
The following study is based on a review of eight patients with hemangioma of the nasal cavity and referred to the Sumitomo Hospital spanning the years 1999–2001. All the patients had no history of nasal trauma or previous surgery. The age and gender of the patients are shown in Table 1. CT was performed in five patients, and six underwent magnetic resonance imaging (MRI), which demonstrated intranasal masses. Our series includes only one preoperative biopsy case performed in another hospital
Results
In all cases, rhinoscopy showed a purplish mass that filled the nasal cavity.
All masses were well-circumscribed with no internal calcification or phlebolites on CT scans. The nasal septum was displaced in two cases (Fig. 1), but the bone around the tumor was not eroded. MR images revealed all masses were located in the nasal cavity, and no invasion to paranasal sinuses was noticed. All the tumors were enhanced with Gd-DTPA on T1-weighted magnetic resonance images and showed high signal
Discussion
The presence of a bleeding nasal mass is consistent with various malignant and benign lesions. Although hemangioma of the head and neck are common. Over half of all hemangiomas are located in the head and neck region and can originate in the skin, mucosae and deep structures such as bones, muscles and glands. In the nasal cavity, about 80% of hemangiomas arise from the nasal septum in the area known as the Little area or Kiesselbach triangle. Another 15% arise from the lateral wall of the nasal
Conclusion
From this study it is possible to draw some conclusions:
CT scanning and MR imaging were useful in identifying the extension of the tumor and planning for the endoscopic transnasal surgery.
We suggest transnasal endoscopic approach can be taken for intranasal hemangioma limited to thenasal cavity to nasopharynx, and extended into ethomoid to sphenoid sinus.
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2020, International Journal of Surgery Case ReportsCitation Excerpt :Even with the uncertainty of diagnosis, practitioners should be aware of the clinical, histological and radiological characteristics of sinonasal hemangiomas to avoid the consequences of a wrong diagnosis [5,7]. CT angiography is a valuable modality in visualizing vascular malformations and identifying the feeding vessel to the tumor, moreover, it can help in deciding the approach and possibility of using preoperative embolization [12,13]. Preoperative embolization has been shown to be effective in decreasing tumor size and minimizing intra and postoperative bleeding [3,5,7,14].
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