J Korean Assoc Oral Maxillofac Surg.  2023 Oct;49(5):304-307. 10.5125/jkaoms.2023.49.5.304.

Late side effects of bleomycin injection into the lower lip mucosa of a nine-year-old patient with venous malformation

• Mustakim KR
• Kim SM

• KMID: 2547576
• DOI: http://doi.org/10.5125/jkaoms.2023.49.5.304

Abstract

Venous malformation (VM) is a benign lesion of blood vessels caused by an error in vascular morphogenesis during the embryologic phase. This entity mostly affects the head and neck region, including the lips, tongue, buccal mucosa, gingiva, or palate. VM may cause functional and aesthetic impairments. The anatomical structure and shape of the lips provide an important aesthetic accent for an individual. Therefore, management of VM in the lip area without postoperative defects or scarring is challenging. In this brief communication article, we present a conservative approach to lip VM in a nine-year-old boy using a bleomycin injection that had good aesthetic and functional outcomes. Injection of 2 mL of 1/10 of 15 mg bleomycin in a saline dilution into the lip mucosa may present a drug reaction as a white plaque and reddish owl eye lesion that takes up to three weeks to resolve without a scar. It is important to recognize the characteristics and self-limiting nature of postoperative bleomycin complications to avoid unnecessary treatment.

Keyword

Arteriovenous malformation; Bleomycin; Drug side effects; Pediatrics; Sclerotherapy

Figure

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  Fig. 1 Post-injection/operative day (PID) clinical appearance. Immediate PID appearance (A). A well-demarcated, smooth white plaque was observed on PID 3 (B). A reddish owl eye lesion was noticed on PID 6 and was characterized by indurated swelling with a red scab surrounded by a whitish plaque (C, D). On PID 7 (E), PID 8 (F), and PID 9 (G), the swelling was reduced. At PID 10, the reddish owl eye lesion had resolved (H). Uneventful healing took place on PID 11 (I), PID 12 (J), and PID 13 (K), and the scab was gradually replaced by regenerated mucosa. The lip was fully healed after three weeks (L).

Reference

References

1. Couto DAF, Ito FA, Lima HG, Novais JD, Novais JB, Dallazen E, et al. 2019; Sclerotherapy for extensive vascular malformation in the tongue. J Craniofac Surg. 30:e796–9. https://doi.org/10.1097/scs.0000000000005788. DOI: 10.1097/SCS.0000000000005788. PMID: 31403517.

2. Zeevi I, Chaushu G, Alterman M, Chaushu L. 2020; Sclerotherapy of vascular malformations in the oral cavity-minimizing postoperative morbidity. Medicina (Kaunas). 56:254. https://doi.org/10.3390/medicina56050254. DOI: 10.3390/medicina56050254. PMID: 32456057. PMCID: PMC7279465.

3. Bajpai H, Bajpai S. 2012; Comparative analysis of intralesional sclerotherapy with sodium tetradecyl sulfate versus bleomycin in the management of low flow craniofacial soft tissue vascular lesions. J Maxillofac Oral Surg. 11:13–20. https://doi.org/10.1007/s12663-011-0325-7. DOI: 10.1007/s12663-011-0325-7. PMID: 23449774. PMCID: PMC3319813.

4. Min HG, Kim SG, Oh JS, You JS. 2015; Sclerotherapy using 1% sodium tetradecyl sulfate to treat a vascular malformation: a report of two cases. J Korean Assoc Oral Maxillofac Surg. 41:322–6. https://doi.org/10.5125/jkaoms.2015.41.6.322. DOI: 10.5125/jkaoms.2015.41.6.322. PMID: 26734559. PMCID: PMC4699933.

5. Berenguer B, Burrows PE, Zurakowski D, Mulliken JB. 1999; Sclerotherapy of craniofacial venous malformations: complications and results. Plast Reconstr Surg. 104:1–11. discussion 12–5. DOI: 10.1097/00006534-199907000-00003. PMID: 10597669.

6. Song D, Guo L, Sheng H, Li J, Wang L, Wu C, et al. 2020; DSA-guided percutaneous sclerotherapy for children with oropharyngeal low-flow venous malformation. Exp Ther Med. 19:3405–10. https://doi.org/10.3892/etm.2020.8581. DOI: 10.3892/etm.2020.8581. PMID: 32266040. PMCID: PMC7132246.