An unusual case of vascular malformation requiring additional orthodontic, swallowing and voice therapy after intralesional Bleomycin injection

Vascular malformations are errors of the vascular morphogenesis. Depending on the dominating vessel of the lesion, we can describe several types of malformations: capillary, venous, arterial, lymphatic and mixed. We report the case of a 12 year old child who presented at birth a mixed venous and lymphatic malformation at several levels, includind tongue, oral cavity, vestibular cavity and chin.As the child did not respond to the medical treatment, he was proposed an embolization procedure after having undergone a previous venography in a different medical center. Due to the high costs of such a procedure, the beginning of the treatment with intralesional Bleomycin injection has been decided. Bleomycin, a polypeptidic antineoplasic antibiotic, was recently introduced in the treatment of vascular anomalies as sclerosant agent if injected intralesionally. After 5 injections under general anesthesia, the lesions disappeared; the lesions didn't reappear and even more, the tongue returned to its normal proportions.The vascular malformation which determined macroglossia since birth, affected during its development, the entire oral cavity. Nowadays, the child whose tongue returned to its normal proportion after 12 years cannot achieve a frontal occlusion which creates discomfort during mastication; the child must still undergo several orthodontical and surgical correcting procedures and a speech training