We reported a case of varicosities in the buccal mucosa treated with sclerotherapy. The sclerosant agent used was the monoethanolamine  oleate. After three sessions the lesions disappeared and the patient is follow-up

Castro, Wagner Henriques

Gala García, Alfonso

Gomes, Carolina Cavalieri

Gomez, Ricardo Santiago

Mesquita, Ricardo Alves

Vieira  do Carmo, María Auxiliadora

English

Repositori d'Objectes Digitals per a l'Ensenyament la Recerca i la Cultura

E44Oral Surgery                                                                                                           Varicosities treated with monoethanolamine oleate                                                             Med Oral Patol Oral Cir Bucal 2006;11:E44-6.                                                        Varicosities treated with monoethanolamine oleateMucosal varicosities: case report treated with monoethanolamine oleateCarolina Cavalieri Gomes  1, Ricardo Santiago Gomez 2, Maria Auxiliadora Vieira do Carmo 2, Wagner Henriques Castro 3, Alfonso Gala-García 4, Ricardo Alves Mesquita 2  (1) Pos-graduate student(2)  Professor. Oral Surgery, Oral Medicine and Oral Pathology Department(3) Professor. Oral Surgery, Oral Medicine and Oral Pathology Department(4) Pos-graduate student. Oral Surgery, Oral Medicine and Oral Pathology Department. Dentistry School, Federal University of Minas Gerais, BrazilCorrespondence:Prof. Ricardo Alves de MesquitaFaculdade de Odontologia da UFMGDisciplina de Patologia Bucal, sala 3204Av. Antônio Carlos, 6627Pampulha 31270-901BELO HORIZONTE-MG     BRASILFax: (31) 3499-2472; (31) 3499-2430E-mail: ramesquita@ufmg.brReceived: 19-06-2005   Accepted: 16-08-2005Cavalieri-Gomes C, Santiago-Gomez R, Vieira-do Carmo MA, Henriques-Castro W, Gala-García A, Alves-Mesquita R.  Mucosal varicosities: case report treated with monoethanolamine oleate. Med Oral Patol Oral Cir Bucal 2006;11:E44-6.© Medicina Oral S. L. C.I.F. B 96689336 - ISSN 1698-6946ABSTRACTWe reported a case of varicosities in the buccal mucosa treated with sclerotherapy. The sclerosant agent used was the mo-noethanolamine oleate. After three sessions the lesions disappeared and the patient is follow-up.Key words: Sclerotherapy, monoethanolamine oleate, treatment, oral varicosities.RESUMENDescribimos un caso clínico de varices en la mucosa yugal que fue tratado con escleroterapia. El agente esclerosante usado fue oleato de monoetanolamina. Después de la tercera sesión las varices desparecieron y la paciente mejoro.Palabras clave: Escleroterapia, oleato de monoetanolamina, tratamiento, varices orales.Indexed in: -Index Medicus / MEDLINE  /  PubMed        -EMBASE, Excerpta Medica-Indice Médico Español                                                        -IBECS© Medicina Oral S.L. Email: medicina@medicinaoral.comClick here to view the article in SpanishOral Surgery                                                                                                           Varicosities treated with monoethanolamine oleate                                                             Med Oral Patol Oral Cir Bucal 2006;11:E44-6.                                                        Varicosities treated with monoethanolamine oleateE45INTRODUCTIONHemangioma, vascular malformation and varicosities are be-nign lesions of blood vessels frequently found in the head and neck regions, including the oral mucosa and lips (1). Mulliken & Glowack in 1982 (2) differentiated the generic term heman-gioma in two entities: vascular malformation and hemangioma. Recently, in the oral mucosa, vascular malformation has gained a separated recognition from that of hemangioma (3).Varicosities are acquired lesions of a vein, artery or lymphatic vessels abnormally dilated and winding, which causes are uncertain. Age, tissue loosening and increase from the venous pressure are predisposing factors. The varicosities are rare in infants, however common in adults (4).The incidences of oral varicosities was 59.6% in elderly Thai patients and the varico-sities veins under the tongue was 4.0% in patients of Finland (5,6). Oral varicosities presented as purplish blue spots, nodules or ridges, usually asymptomatic. Most commonly involved the lingual renine veins or vessels of the ventral surface of the ton-gue and the floor of the mouth. Lips and buccal mucosa are less common sites. The history and a careful physical examination are sufficient to establish a clinical diagnose in most of cases of oral varicosities (4-6).Oral varicosities localized on the lips or buccal mucosa are prone to trauma and so treatment should be considered to these cases. Cryosurgical has been used in the management of the oral varicosities (7). We reported a case of mucosal varicosities treated with sclerotherapy.CASE REPORTA 60-years-old white woman was referred to the Oral Medicine Clinic of the Dentistry School (UFMG) to evaluate painless lesions in the mouth. Medical history revealed controlled systemic arterial hypertension and varicosities of the legs. At the intraoral examination three bluish purple nodules were present. Two lesions were displaced on the right side of the buccal mucosa adjacent to the oral commeasure and measuring about 10x10mm in diameter each one, and the other nodule was sublingual and measuring about 5x5mm (Figure 1A). The patient reported that these lesions had been present for 20 years. Clinical history and examination led to the diagnosis of mucosal varicosities and they were treated with 2.5% monoethanolamine oleate (EO). The treatment consisted of intraluminal injection of 1.0ml 2.5% MO divided in four or five points. The intralu-minal position was confirmed by blood aspiration. After the solution being slowly injected, the lesions were compressed with cotton gauze. The patient was submitted to three sessions of sclerotherapy in each lesion with two weeks of interval one from another. The lesions disappeared after three sessions and no recurrence was observed after 30 months (Figure 1B).DISCUSSIONVaricosities or varix is an abnormally dilated and tortuous vein. The exact cause of oral varicosities is uncertain. Age is an im-portant factor because oral varicosities are rare in children but common in older adults (4-6). In addition, older adult present tissue loosening, that is other predisposing factor. Varicosities have not been associated with systemic hypertension or other Fig. 1. A- Two bluish purple nodules in the right buccal mucosa. B- Aspect clinical of the patient within varicosities after of the treatment with sclero-therapy.E46Oral Surgery                                                                                                           Varicosities treated with monoethanolamine oleate                                                             Med Oral Patol Oral Cir Bucal 2006;11:E44-6.                                                        Varicosities treated with monoethanolamine oleatecardiopulmonary diseases (4). However, Colby et al. in 1961 (8) found that people with varicosities of the legs were more likely to develop varicosities on the tongue. The patient of this case report is an older adult and has varicosities on the legs. This fact associated with oral clinical features was important to establish the clinical diagnosis of mucosal varicosities.Due to trauma, varicosities located on the lips or buccal mucosa sometimes requires treatment. Few modalities of treatment of oral varicosities are described in the literature. Tal & Gor-sky (7) reported a management of mucosal varicosities with cryosurgery. In our clinic sclerotherapy is the main choice in such cases.Sclerotherapy is an effective and conservative technique for the treatment of benign vascular lesions. Sclerotherapy with EO is a safe and efficient treatment for vascular benign lesions located in various regions of the body (9,10). EO as sclerosant agent has been widely used in the management of the esophageal varicosities (11-15).Our patient reported pain, swelling, redness and/or burning after the application of EO, but for only 72 hours. Similar symptoms were already reported (9). The results of sclerotherapy were considered successful in esthetic and functional points of view by the dentistry and the patient.REFERENCES1. Finn MC, Glowacki J, Mulliken JB. Congenital vascular lesions: clinical application of a new classification. J Pediatr Surg 1983;18:894-900.2. Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plastic Reconstr Surg 1982;69:412-22.3. Neville BW, Damm DD, Allen CM, Bouqout JE. Oral & Maxillofacial Pathology. 2ed. Philadelphia: Saunders; 2002. p. 337-69.4. Kleinman HZ. Lingual varicosities. Oral Surg Oral Med Oral Pathol 1967;23:546-8.5. Nevalainen MJ, Narhi TO, Ainamo A. Oral mucosal lesions and oral hygiene habits in the home-living elderly. J Oral Reab 1997;24:332-7.6. Jainkittivong A, Aneksuk V, Langlais RP. Oral mucosal conditions in elderly dental patients. Oral Dis 2002; 8:218-23.7. Tal H, Gorsky M. Cryosurgical treatment of a buccal varix. J Oral Med 1987;42:63-5. 8. Colby RA, Kerr DA, Robson HBG. Color Atlas of Oral Pathology, 2ed, Philadelphia: J.B. Lippincott Company; 1961. p.125.9. Choi YH, Han MH, O-Ki K, Cha SH, Chang K-H. Craniofacial Cavernous Venous Malformations: percutaneous scleroterapy with use of ethanolamine oleate. J Vasc Interv Radiol 2002;13:475-82.10. Matsumoto K, Nakanishi H, Yoshio K, Seike T, Kanda I, Kubo Y. Sclerothe-rapy of hemangioma with late involution. Dermatol Surg 2003;29:668-71.11. Neeman A, Leiser A, Kadish U. Treatment of esophageal varces: low versus hight dose of 5 % ethanolamine oleate. Am J Gastroenterol 1991;86:1182-4. 12. Nishida R, Inoue R, Takimoto Y, Kita T. A sclerosant with astringent proper-ties developed in China for oesophageal varices: comparison with ethanolamine oleate and polidocanol. J Gastroenterol Hepatol 1999;14:481-8.13. Meireles-Santos JO, Carvalho AF Jr, Callejas-Neto F, Magna LA, Yama-naka A, Zeitune JMR, et al. Absolute ethanol and 5% ethanolamine oleate are comparable for sclerotherapy of esophageal varices. Gastrointest Endosc 2000;51:573-6.14. Iso MA, Kitano S, Iwanga T, Koyanagi N, Sugimachi K. A prospective randomized study comparing the effects of large and small volumes of the sclerosant 5% ethanolamine oleate injected into esophageal varices. Endoscopy 1988;20:285-8.15. Johann ACBR, Aguiar MCF, do Carmo MAV, Gomez RS, Castro WH, Mesquita RA. Sclerotherapy of benign oral vascular lesion with ethanolamine oleate: An open clinical trial with 30 lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; (in press).AcknowledgmentThe authors thank CNPq for assistance. Mesquita RA and Gomez RS are research fellows of the CNPq. 

Mucosal varicosities : case report treated with monoethanolamine oleate

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Mucosal varicosities : case report treated with monoethanolamine oleate

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