Subcutaneous Cavernous Hemangioma in the Nasal Dorsum: Report of Case Treated with Endoscopic Rhinoplasty

Abstract

Introduction Hemangiomas are vascular malformations, with slow blood flow, that can occur in any part on the body. They are more common in women and, predominantly, are isolated lesions. The malformation does not spontaneously regress. Subcutaneous hemangioma is a rare variant with an aggressive growth pattern that sometimes recurs after excision. Objective Case report of a subcutaneous cavernous hemangioma in the nasal dorsum treated with endoscopic rhinoplasty. Case Report A 27-year-old woman had a fibroelastic tumor mass in the midline of the nasal dorsum, which was pulsatile; she had obstruction and nasal congestion with associated rhinorrhea, with evolution and worsening over the previous 2 years. Computed tomography showed a tumor demarcated in the nasal dorsum without evidence of intracranial communication. Endoscopic rhinoplasty with septoplasty and associated paranasal sinus sinusectomy was performed without arteriography embolization, sclerotherapy, or laser. Pathologic diagnosis showed cavernous hemangioma. Postoperative follow-up shows no recurrence at 3 years. Discussion This case presented with atypical features, thus making the diagnosis a challenge. Imaging studies were required to confirm the vascular nature of the tumor. Excisional biopsy is the procedure of choice for pathologic examination. Subcutaneous hemangiomas never involute and always need treatment. The surgical approach is exceptional because there was no preoperative diagnosis. In addition, the closed technique provided best aesthetic results in this case. Conclusion Endoscopic rhinoplasty is suitable for nasal dorsum tumor resection and has superior aesthetic result to open techniques.

Subcutaneous hemangioma on nasal dorsum: a case report

“…However, the imaging workup is necessary to confirm the vascular nature and identify venous, arterial, and lymphatic components as well as the involvement of deeper structures and intracranial connections. A negative result of a CT scan to elucidate the connection between the mass and the central nervous system does not exclude the intracranial connection [ 10 , 11 ]. Vilanova et al preferred to use magnetic resonance imaging and magnetic resonance angiography to differentiate the type of hemangioma due to its capacity to confirm the diagnosis, determine the extent of the anomaly, classify the lesion appropriately, and document the associated abnormalities [ 12 ].…”

A unilateral dermatomal venous malformation

“…VMs are congenital malformations that are present at birth, when they are still incipient 15 . Proportionate to a child's growth, a VM may evolve, and its growth rate can also be triggered by hormonal change, local pressure, or an injury 16 …”