From the Guidelines
Management of base of tongue hemangiomas requires a tailored approach, with first-line medical therapy typically involving propranolol at 2-3 mg/kg/day divided into three doses for 6-12 months, as recommended by the clinical practice guideline for the management of infantile hemangiomas 1. For small, asymptomatic hemangiomas, observation with regular follow-up is often sufficient as many may involute spontaneously, particularly in children. For symptomatic lesions causing dysphagia, airway obstruction, or bleeding, active intervention is necessary. The following key points should be considered in the management of base of tongue hemangiomas:
- Blood pressure and heart rate should be monitored during treatment initiation with propranolol 1.
- Corticosteroids (prednisolone 2-3 mg/kg/day for 4-8 weeks with gradual tapering) may be used when propranolol is contraindicated 1.
- For persistent or large lesions, surgical excision via transoral approach, laser ablation (CO2 or KTP laser), or radiofrequency ablation can be considered, as recommended by the clinical practice guideline for the management of infantile hemangiomas 1.
- Sclerotherapy using agents like sodium tetradecyl sulfate or bleomycin is another option for accessible lesions.
- Embolization may be necessary pre-operatively for extensive vascular lesions to reduce bleeding risk. The management approach should balance efficacy against potential complications including airway compromise, which may require securing the airway before intervention in some cases. It is essential to consult with a hemangioma specialist, especially in young infants, to determine the best course of treatment 1.
From the Research
Management Options
- Surgical excision: In some cases, surgical excision may be necessary, especially if the hemangioma is causing repeated bleeding episodes or difficulty accessing the area 2.
- Transoral Ultrasonic Surgery (TOUSS): A novel procedure using Thunderbeat© has been reported to be effective in removing hemangiomas from the base of the tongue 3.
- Propranolol: This medication has been shown to be effective in treating airway hemangiomas, including subglottic hemangiomas, with significant improvement in symptoms and reduction in airway obstruction 4, 5, 6.
Treatment Considerations
- Diagnosis: A high index of suspicion and radiological investigations should be performed if the clinical presentation is atypical for malignancy 2.
- Age: Hemangiomas can occur at any age, but are more common in infants and children 3.
- Dosing: The optimal dose of propranolol for treating subglottic hemangiomas is not established, but higher doses (3 mg/kg/day) may be beneficial 6.
- Concurrent steroids: The use of concurrent steroids may be associated with a higher treatment failure rate 6.
Outcomes
- Successful treatment with propranolol can result in rapid airway stabilization, obviating the need for operative intervention, and reducing the duration of systemic corticosteroid therapy 5.
- Surgical excision can result in complete removal of the hemangioma with no recurrence or bleeding episodes 2.
- TOUSS can achieve the same advantages as other surgical procedures with lower costs and shorter learning curve 3.