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Case report of hemangiomas of tongue and cheek treated with radium
M
MS 11. S., white, aged 35 years, applied for treatment of hemangiomas of the tongue and right cheek upon the advice of her dentist, and the suggcslion of a friend who had a similar condition treated at our institution successfully. She had no other complaint. Th? patient wore glasses for the relief of headaches. She had had an appendectomy fourteen years before; otherwise, her medical hist,ory was negative.
Fig.
1.-A,
Sormal
half
of tongue:
B, hemangioma hemangioma in
on tongue; cheek.
C, hemangionm
in check:
II,
l’hysical examination was essentially negative. Blood pressure was 140/90. Urinalysis and Kline tests were negative. There were no hemangiomas aside from those in the oral cavity, nor were any other abnormalities present. She had most of her teeth, although the lower right first and second molars were missing. Her mouth was in a fairly good state. School
of Dental
and
Oral
Surgery,
Columbia
University.
74
E. Beder and
Oscar
Daniel E. Ziskin
Examination disclosed the presence of a large hemangioma of the tongue, occupying the anterior two-thirds of the dorsum on the right side (about 7 cm.). Another was present on the inner surface of the right cheek, about 5 by 2.5 cm., extending forward to involve the vermilion border of the lower lip. Both were bulky (Fig. 1). In addition, there were a 1 cm. hemangioma of the ventral surface of the left side of the tongue and an 0.5 cm. hemangioma on the vermilion border of the lower left lip. culty.
All were present since infancy and had never caused the patient any diffiOnly the two large tumors on the right side were to be treated at the time.
-
I
Fig.
2.
Fix.
3
Therapy consisted of the application of radium encased in small platinum tubes about 2 mm. in diameter and 1 cm. in length. Appliances were constructed in such a way as to serve both as a medium for holding t,he radium in proper position in relation to the hemangiomas and to protect the neighboring normal Prior to the construction of this device, a molar tissues from scatter radiation. (lower right) and the lower right first and second bicuspids, in the line of radiation and not essential to future prosthetic restoration, were extracted.
Bemangiomas
of Totzgue and Cheek
A description of the construction of the appliances follows: The first step was to cut a U-shaped piece of sheet lead, sAs inch in thickness, in such a manner that it fit underneath the tongue when the latter was fully extended, and still left a border of 1/s inch. This form was then put into position, with the tongue extended, and a plaster impression was t,aken of the tongue. A stone model was poured. Using the latter as a guide, another lead sheet, $6 inch thick, was shaped so as to cover the area of the lesion and yet leave enough space for the wax to hold the radium capsules and also to allow for a distance of 1 cm. bet,ween the radium and the tissue. Wax, This form was then attached to a metal tongue depressor instrument. Next, in thickness about 1 cm., was added to the surface for holding the radium. all exposed lead was covered with baseplate wax to prevent secondary irradiation. Radium capsules were put in place; the lower lead sheet, also wax-covered, was put beneath the tongue; the upper part was placed. The patient was now ahlc to hold the appliance in position for the prescribed length of time (Figs. 2 and 3). The device used in the cheek was made in the following manner : A piece of wooden tongue depressor blade was used as a. tray around which was placed a This was then put into the mouth on the side bulk of soft modeling compound. The area pushof the lesion, and the patient was told to bite into the compound. ing out the cheek was molded by gently massaging the cheek. The patient was instruct,ed to mold t,he lingual portion with the tongue.
LEAD HENAU6/onq RAzmu~ CAPSULC
Fig.
4.
After the compound hardened, it was removed, the window cut out, flasked, boiled out, and then the mold tinfoiled. Some clear acrylic was put’ into the mold to partly fill it, and lead (l/s inch thick) was placed in position as shown in Fig. 4. The mold was then filled with the acrylic and processed. The appliance was polished to prevent irritation to the tissues. Radium capsules were placed in wax put in the window. Retention of the appliance is maintained by the teeth biting into the spaces produced by them originally in the impression compound. The radium succeeded in reducing the bulk of both hemangiomas treated. On the tongue, only the posterior third of the hemangioma remains. On the cheek, however, the whole lesion is still present, though greatly reduced in bulk. The patient is now receiving injections with a sclerosing solution in a further attempt to reduce the size of the hemangioma in the cheek.
MS 11. S., white, aged 35 years, applied for treatment of hemangiomas of the tongue and right cheek upon the advice of her dentist, and the suggcslion of a friend who had a similar condition treated at our institution successfully. She had no other complaint. Th? patient wore glasses for the relief of headaches. She had had an appendectomy fourteen years before; otherwise, her medical hist,ory was negative.
Fig.
1.-A,
Sormal
half
of tongue:
B, hemangioma hemangioma in
on tongue; cheek.
C, hemangionm
in check:
II,
l’hysical examination was essentially negative. Blood pressure was 140/90. Urinalysis and Kline tests were negative. There were no hemangiomas aside from those in the oral cavity, nor were any other abnormalities present. She had most of her teeth, although the lower right first and second molars were missing. Her mouth was in a fairly good state. School
of Dental
and
Oral
Surgery,
Columbia
University.
74
E. Beder and
Oscar
Daniel E. Ziskin
Examination disclosed the presence of a large hemangioma of the tongue, occupying the anterior two-thirds of the dorsum on the right side (about 7 cm.). Another was present on the inner surface of the right cheek, about 5 by 2.5 cm., extending forward to involve the vermilion border of the lower lip. Both were bulky (Fig. 1). In addition, there were a 1 cm. hemangioma of the ventral surface of the left side of the tongue and an 0.5 cm. hemangioma on the vermilion border of the lower left lip. culty.
All were present since infancy and had never caused the patient any diffiOnly the two large tumors on the right side were to be treated at the time.
-
I
Fig.
2.
Fix.
3
Therapy consisted of the application of radium encased in small platinum tubes about 2 mm. in diameter and 1 cm. in length. Appliances were constructed in such a way as to serve both as a medium for holding t,he radium in proper position in relation to the hemangiomas and to protect the neighboring normal Prior to the construction of this device, a molar tissues from scatter radiation. (lower right) and the lower right first and second bicuspids, in the line of radiation and not essential to future prosthetic restoration, were extracted.
Bemangiomas
of Totzgue and Cheek
A description of the construction of the appliances follows: The first step was to cut a U-shaped piece of sheet lead, sAs inch in thickness, in such a manner that it fit underneath the tongue when the latter was fully extended, and still left a border of 1/s inch. This form was then put into position, with the tongue extended, and a plaster impression was t,aken of the tongue. A stone model was poured. Using the latter as a guide, another lead sheet, $6 inch thick, was shaped so as to cover the area of the lesion and yet leave enough space for the wax to hold the radium capsules and also to allow for a distance of 1 cm. bet,ween the radium and the tissue. Wax, This form was then attached to a metal tongue depressor instrument. Next, in thickness about 1 cm., was added to the surface for holding the radium. all exposed lead was covered with baseplate wax to prevent secondary irradiation. Radium capsules were put in place; the lower lead sheet, also wax-covered, was put beneath the tongue; the upper part was placed. The patient was now ahlc to hold the appliance in position for the prescribed length of time (Figs. 2 and 3). The device used in the cheek was made in the following manner : A piece of wooden tongue depressor blade was used as a. tray around which was placed a This was then put into the mouth on the side bulk of soft modeling compound. The area pushof the lesion, and the patient was told to bite into the compound. ing out the cheek was molded by gently massaging the cheek. The patient was instruct,ed to mold t,he lingual portion with the tongue.
LEAD HENAU6/onq RAzmu~ CAPSULC
Fig.
4.
After the compound hardened, it was removed, the window cut out, flasked, boiled out, and then the mold tinfoiled. Some clear acrylic was put’ into the mold to partly fill it, and lead (l/s inch thick) was placed in position as shown in Fig. 4. The mold was then filled with the acrylic and processed. The appliance was polished to prevent irritation to the tissues. Radium capsules were placed in wax put in the window. Retention of the appliance is maintained by the teeth biting into the spaces produced by them originally in the impression compound. The radium succeeded in reducing the bulk of both hemangiomas treated. On the tongue, only the posterior third of the hemangioma remains. On the cheek, however, the whole lesion is still present, though greatly reduced in bulk. The patient is now receiving injections with a sclerosing solution in a further attempt to reduce the size of the hemangioma in the cheek.