Secondary Cleft Lip Induced by Congenital Hemangioma: Report of a Rare Case

Abstract

Infant hemangioma is a relatively rare congenital disease. Ulcer and infection may occur in some cases. A few cases may develop into deformity and defect. Herein, we present a case of secondary cleft lip induced by congenital hemangioma and also our sequential treatment.

Introduction

Ulcerated hemangioma mimicking cleft lip is extremely rare, and only a few individual cases have been reported in the literature. This case report presents our sequential treatment that achieves good curative effect.

Case Report

The patient was born with a congenital hemangioma in the upper lip. At first, it was just a reddish patch. As time goes by, the hemangioma grown and developed into ulceration. She had not received effective treatment until she came to our hospital when she was 3 months old. Physical examination showed the presence of a fissure cleaving the right lateral portion of the philtrum (Figure 1A). Reddish tumor visible at both sides of the fissure led us to diagnose a congenital ulcerated hemangioma mimicking cleft lip.

Figure 1.

A, Before treatment. B, Five months after 2 rounds of the treatment of local injection of pingyangmycin combined with Nd:YAG laser therapy. C, Two months after surgical repair of the cleft lip.

We developed a sequential treatment regimen for her. First she underwent 2 rounds of the treatment of local injection of pingyangmycin combined with Nd:YAG laser therapy, with an interval of 1 month. Seven months later, the lesion had significantly shrunk (Figure 1B).Then the patient received surgical repair of the cleft lip. The defects were satisfactorily reconstructed in the shape of lip (Figure 1C).

Discussion

Ulcer is one of the most common complications of congenital hemangioma, ¹ often occurring at the height of the proliferative phase ² and on the sites of abrasion or friction, such as the lips. ³ The exact pathogenesis of this disease is still unknown. Ulcerated hemangioma mimicking cleft lip is a rare complication, and only a few individual cases have been reported in the literature. ⁴

In the past decades, with the development of medical technology, the treatment of hemangioma was also improving. Many modalities have been used, including propranolol, operative therapy, ⁵ corticosteroids, interferon-α-2a/2b, laser therapy, sclerotherapy, cryosurgery, embolization, and radiation therapy. ⁶ In our case, the treatment of local injection of pingyangmycin combined with Nd:YAG laser therapy achieved a satisfactory curative effect.

Surgery is the only way to repair deformity of ulcerated hemangioma mimicking cleft lip. But when to operate is a question remains to be discussed. We have 2 points on this issue. First, surgery could be performed after the paracmastic stage has begun. Second, on the basis of the first point, as early as possible.