| disease | Nasal Hemangioma |
Vascular tumors in the nasal region are predominantly hemangiomas, with other rare tumors including hemangioendotheliomas, hemangiopericytomas, fibrohemangiomas, angiofibromas, and hemangiolymphangiomas. Hemangiomas are congenital benign tumors or vascular malformations. Nasal hemangiomas most commonly occur within the nasal cavity, particularly on the nasal septum, but can also develop in the nasal bones, nasal vestibule, and maxillary sinus.
bubble_chart Etiology
The disease causes of nasal hemangioma include the following theories:
1. Embryonic remnant theory: Nasal septal hemangioma originates from embryonic maternal vascular cells.
2. Chronic inflammation theory: For example, hemorrhagic polyps may arise from vascular degeneration in granulation tissue. Some also believe that cavernous hemangioma of the maxillary sinus is caused by polyp torsion, venous stasis, and other nutritional disturbances.
3. Trauma theory: The anterior inferior part of the nasal septum is prone to trauma and dryness, and capillary hemangiomas often occur in this area, possibly related to trauma.
4. Endocrine theory: Nasal cavity hemangiomas may suddenly appear or enlarge during pregnancy and shrink after childbirth. They often occur in the late stage of pregnancy [third trimester], possibly related to circulatory disturbances or endocrine activity at that time.
5. True benign tumor.
bubble_chart Pathological Changes
Hemangiomas can generally be classified into three types based on clinical manifestations and histological features: capillary hemangioma, cavernous hemangioma, and racemose hemangioma. Additionally, there is a mixed type where capillary hemangioma combines with cavernous hemangioma.
Hemangiomas vary in size and may have a slender pedicle or a broad base. Capillary hemangiomas are usually smaller and often pedunculated, while cavernous hemangiomas are larger with a broad base. They appear red, purple, or dark red, and are round, oval, or mulberry fruit-shaped. They are soft and elastic in texture, and prone to bleeding. Cavernous hemangiomas are soft and compressible, frequently occurring near the natural opening of the maxillary sinus and the inferior turbinate. Large tumors may compress the sinus walls, erode bone tissue, and invade adjacent organs.bubble_chart Clinical Manifestations
The clinical manifestations of nasal and sinus hemangiomas vary depending on the duration of the disease and the extent of the lesions. Nasal hemangiomas primarily present with unilateral progressive nasal obstruction. If the tumor causes deviation of the nasal septum, bilateral nasal obstruction may occur. Recurrent epistaxis is a prominent feature of this condition, with varying amounts of bleeding. Severe bleeding can lead to secondary anemia. Early-stage sinus hemangiomas may be asymptomatic, but as the lesion enlarges, symptoms such as nasal obstruction and epistaxis may appear. The hemangioma may protrude anteriorly through the nostril or extend posteriorly into the nasopharynx, causing eustachian tube obstruction. Larger tumors can expand the sinus cavity, leading to compression, absorption, thinning, or even destruction of the bony walls. If the tumor extends externally, it may result in facial deformity, exophthalmos, eyeball displacement, decreased vision, diplopia, or headache.
Examination of the nasal cavity reveals a purplish-red neoplasm with a soft constitution, often compressible and yielding, prone to bleeding upon touch but without signs of infiltration. If secondary infection occurs, the surface may exhibit erosion, necrosis, and polyps. If the lesion is confined to the sinus, the nasal cavity may show no changes, making diagnosis difficult. Puncturing the maxillary sinus may yield blood. Plain X-ray findings may include: ① Uniformly increased density in the nasal cavity and ipsilateral maxillary and ethmoid sinuses, resembling inflammatory changes; ② Enlargement of the maxillary sinus cavity with increased density, resembling cystic changes; ③ Destruction of the sinus wall bone, resembling malignant tumor changes. Hemangiomas often present with concurrent infection and necrosis, and biopsy specimens may not reflect the true condition of the disease, while also being prone to causing bleeding. However, small pedunculated hemangiomas can be excised in one procedure for pathological sectioning to confirm the diagnosis.
bubble_chart Treatment Measures
Surgical resection is the primary treatment method. For nasal septal capillary hemangiomas (also known as nasal septal hemorrhagic polyps) or smaller hemangiomas originating in the nasal cavity, they can be excised through the anterior nasal aperture. During surgery, the cartilage membrane at the tumor's base should also be removed to prevent recurrence. For larger, broad-based, and easily bleeding nasal or sinus hemangiomas, resection can be performed via a midface degloving approach or an external nasal route. If necessary, preoperative superselective internal maxillary artery angiography and embolization should be performed to assess the extent of the lesion and reduce intraoperative bleeding. Preoperative radiotherapy can also minimize surgical bleeding, while postoperative radiotherapy helps prevent recurrence and expels pathogens from the exterior.
