A Rare Case of Recurrent Lobular Capillary Hemangioma in an Adult: Diagnosis and Management

TL;DR

This paper describes a rare case of a recurring oral lesion called lobular capillary hemangioma in an adult, focusing on its diagnosis and surgical management.

Contribution

The paper highlights the importance of histopathological diagnosis and complete excision for managing recurrent intraoral LCH.

Findings

Intraoral LCH can cause severe bleeding during excision and requires careful surgical management.

Complete excision from the base of the lesion is crucial to prevent recurrence.

Histopathological examination is essential for accurate diagnosis of LCH.

Abstract

Hyperplastic lesions of the oral cavity appear pink or reddish-blue in colour and soft to firm in consistency. Its onset is always initiated by a traumatic incident or low-grade chronic irritation. Lobular capillary haemangioma (LCH) is one type of hyperplastic lesion that is most commonly initiated by a traumatic incident.

A 27-year-old male patient presented with a recurrent swelling in the front portion of the lower jaw for one year. The lesion was excised from its identified base. Spontaneous, profuse, pulsatile bleeding was observed post excision. The area was isolated with high vacuum suction to improve visibility. A mid-crestal incision was made at the site of bleeding to access deeper tissues, and a flap was reflected to identify the source of bleeding. Once the source of bleeding was identified, the lesion was cauterised deep within the bone to control bleeding. After the bleeding was controlled, the operated site was sutured with silk sutures. A section of the excised lesion was sent for histopathological examination to determine the nature of the lesion. The procedure aimed to both address the immediate concern of bleeding and provide a definitive diagnosis through histopathological examination for appropriate management.

The histopathological report indicating a rich lobular capillary structure with collagen fibres within the central and peripheral parts of the lesion suggested a diagnosis consistent with intraoral LCH. Intraoral LCH is a rare clinical lesion that may lead to severe bleeding during excision. It's crucial for clinicians to be adequately aware of the lesion and its histopathological details. Considering the high vascular appearance of the lesion, it's advisable to consider a prior incisional biopsy to avoid intraoperative complications. Thus, a biopsy can provide valuable information about the nature of the lesion and guide the surgical approach. When excising the lesion, it's important to remove it from its base to minimise the risk of recurrence. Complete excision from the base, which is located deep within the bone, helps ensure that all abnormal tissue is removed, reducing the chances of recurrence. Overall, a thorough understanding of intraoral LCH, including its histopathological features and potential complications, is essential for clinicians to effectively manage and treat the recurrent lesions.

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