Sclerotherapy vs. Laser therapy: Competing or complementary approaches for oral vascular malformations?
DOI:
https://doi.org/10.33448/rsd-v14i8.49374Keywords:
Sclerotherapy, Polidocanol, Mouth Mucosa, Vascular Malformations, Bleomycin.Abstract
Oral vascular malformations (VMs) are low blood flow vascular anomalies that present therapeutic challenges, often requiring minimally invasive approaches. This study aims to evaluate, through a comprehensive literature review, the clinical effectiveness of sclerotherapy and FDIP in managing VMs in the oral cavity, particularly regarding lesion volume reduction and symptomatic relief. This narrative review examined the clinical outcomes of sclerotherapy and forced dehydration with induced photocoagulation (FDIP) in the treatment of oral VMs. A total of ten studies published between 2014 and 2024, encompassing 2,120 patients, were included. The lower lip, tongue, and buccal mucosa were the most affected sites. Monoethanolamine oleate (5%) and polidocanol, particularly in foam form, were the most effective agents, yielding high rates of lesion regression with low complication rates. Pingyangmycin/Bleomycin showed promising results, especially in combination with electrochemical therapy, while sodium tetradecyl sulfate demonstrated lower efficacy but favorable safety. FDIP emerged as an effective alternative, though its broader use is limited by cost. The findings support sclerotherapy as a first-line, safe, and effective treatment for low-flow oral vascular malformations.
References
Balasundaram, I., Al-Hadad, I., Rehman, K., McCafferty, I., & Monaghan, A. (2014). The use of foam sclerotherapy to treat low-flow vascular malformations of the head and neck. Journal of surgical case reports, 2014(9), rju095. https://doi.org/10.1093/jscr/rju095
Berenguer, B., Burrows, P. E., Zurakowski, D., & Mulliken, J. B. (1999). Sclerotherapy of craniofacial venous malformations: complications and results. Plastic and reconstructive surgery, 104(1), 1–15.
Choi, B. E., Kim, Y., Leem, D. H., Baek, J. A., & Ko, S. O. (2016). Utility of sodium tetradecyl sulfate sclerotherapy from benign oral vascular lesion. Maxillofacial plastic and reconstructive surgery, 38(1), 44. https://doi.org/10.1186/s40902-016-0094-9
Clemens, R. K., Pfammatter, T., Meier, T. O., Alomari, A. I., & Amann-Vesti, B. R. (2015). Vascular malformations revisited. VASA. Zeitschrift fur Gefasskrankheiten, 44(1), 5–22. https://doi.org/10.1024/0301-1526/a000402
De Maria, L., De Sanctis, P., Balakrishnan, K., Tollefson, M., & Brinjikji, W. (2020). Sclerotherapy for Venous Malformations of Head and Neck: Systematic Review and Meta-Analysis. Neurointervention, 15(1), 4–17. https://doi.org/10.5469/neuroint.2019.00213
Fernandes, D. T., Elias, R. A., Santos-Silva, A. R., Vargas, P. A., & Lopes, M. A. (2018). Benign oral vascular lesions treated by sclerotherapy with ethanolamine oleate: A retrospective study of 43 patients. Medicina oral, patologia oral y cirugia bucal, 23(2), e180–e187. https://doi.org/10.4317/medoral.22253
Fukuzawa, S., Yamagata, K., Okubo-Sato, M., Terada, K., Uchida, F., Ishibashi-Kanno, N., & Bukawa, H. (2021). Therapeutic Effect of Polidocanol Sclerotherapy on Oral Vascular Malformations. Dentistry journal, 9(10), 119. https://doi.org/10.3390/dj9100119
Górriz-Gómez, E., Vicente-Barrero, M., Loras-Caballero, M. L., Bocanegra-Pérez, S., Castellano-Navarro, J. M., Pérez-Plasencia, D., & Ramos-Macías, A. (2014). Sclerotherapy of face and oral cavity low flow vascular malformations: our experience. The British journal of oral & maxillofacial surgery, 52(1), 43–47. https://doi.org/10.1016/j.bjoms.2013.04.006
He, G., Zhang, L., Guo, L., & Han, A. (2025). Efficacy of sclerotherapy with pingyangmycin and polidocanol for venous malformations. Frontiers in surgery, 12, 1565333. https://doi.org/10.3389/fsurg.2025.1565333
Heimlich, F. V., de Arruda, J. A. A., Kato, C. N. A. O., Silva, L. V. O., Souza, L. N., Ferreira, M. V. L., Pinheiro, J. J. V., Silva, T. A., Abreu, L. G., & Mesquita, R. A. (2024). Experience with 808-nm diode laser in the treatment of 47 cases of oral vascular anomalies. Brazilian oral research, 38, e025. https://doi.org/10.1590/1807-3107bor-2024.vol38.0025
Hammer, F. D., Boon, L. M., Mathurin, P., & Vanwijck, R. R. (2001). Ethanol sclerotherapy of venous malformations: evaluation of systemic ethanol contamination. Journal of vascular and interventional radiology : JVIR, 12(5), 595–600. https://doi.org/10.1016/s1051-0443(07)61482-1
Hoque, S., & Das, B. K. (2011). Treatment of venous malformations with ethanolamine oleate: a descriptive study of 83 cases. Pediatric surgery international, 27(5), 527–531. https://doi.org/10.1007/s00383-010-2824-x
Johann, A. C., Aguiar, M. C., do Carmo, M. A., Gomez, R. S., Castro, W. H., & Mesquita, R. A. (2005). Sclerotherapy of benign oral vascular lesion with ethanolamine oleate: an open clinical trial with 30 lesions. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, 100(5), 579–584. https://doi.org/10.1016/j.tripleo.2004.12.021
Kato, T., Katayama, Y., Fukuhara, S., Watanabe, T., Yamanaka, S., Nakao, K., & Morimoto, N. (2024). Efficacy of foam sclerotherapy with polidocanol for the management of oral venous malformations. Medicine international, 4(3), 24. https://doi.org/10.3892/mi.2024.148
Legiehn, G. M., & Heran, M. K. (2008). Venous malformations: classification, development, diagnosis, and interventional radiologic management. Radiologic clinics of North America, 46(3), 545–vi. https://doi.org/10.1016/j.rcl.2008.02.008
Manzano, B. R., Premoli, A. M., Santaella, N. G., Ikuta, C. R. S., Rubira, C. M. F., & Santos, P. S. D. S. (2019). Sclerotherapy as an esthetic indication in oral vascular malformations: a case series. Anais brasileiros de dermatologia, 94(5), 521–526. https://doi.org/10.1016/j.abd.2019.09.010
Mukul, S. K., Singh, A., Kumar, A., Pandey, S., Singh, S., & Kumar, A. (2019). Foam Polidocanol Sclerotherapy for Low-Flow Vascular Malformations of Tongue. Annals of maxillofacial surgery, 9(2), 257–260. https://doi.org/10.4103/ams.ams_81_19
Pereira, A. S. et al. (2018). Metodologia da pesquisa científica. [free ebook]. Santa Maria: Editora da UFSM.
Ribeiro, M. C., de Mattos Camargo Grossmann, S., do Amaral, M. B. F., de Castro, W. H., Navarro, T. P., Procopio, R. J., da Silva, T. A., de Nazaré Alves de Oliveira Kato, C., & Mesquita, R. A. (2018). Effectiveness and safety of foam sclerotherapy with 5% ethanolamine oleate in the treatment of low-flow venous malformations in the head and neck region: a case series. International journal of oral and maxillofacial surgery, 47(7), 900–907. https://doi.org/10.1016/j.ijom.2017.12.004
Schmitt, N., Lorenz, J., Hohenstatt, S., Semmelmayer, K., Ruping, F., Hoffmann, J., Günther, P., Bendszus, M., Möhlenbruch, M. A., & Vollherbst, D. F. (2023). Sclerotherapy of Venous Malformations Using Polidocanol: Effectiveness, Safety, and Predictors of Outcomes and Adverse Events. Journal of vascular and interventional radiology : JVIR, 34(12), 2103–2109. https://doi.org/10.1016/j.jvir.2023.08.032
Silva, H. C., Teles, A. C., Rocha, G. F., Silveira, E. M., Douglas-de-Oliveira, D. W., & Mesquita, A. T. (2025). Minimally invasive treatment of benign oral vascular lesions: A retrospective study. Medicina oral, patologia oral y cirugia bucal, 30(2), e217–e223. https://doi.org/10.4317/medoral.26809
Yuan, W., & Wang, X. (2024). Therapeutic evaluation of electrochemical therapy combined with local injection of pingyangmycin for the treatment of venous malformations in the tongue. Frontiers in neurology, 15, 1425395. https://doi.org/10.3389/fneur.2024.1425395
Zeevi, I., Chaushu, G., Alterman, M., & Chaushu, L. (2020). Sclerotherapy of Vascular Malformations in the Oral Cavity-Minimizing Postoperative Morbidity. Medicina (Kaunas, Lithuania), 56(5), 254. https://doi.org/10.3390/medicina56050254
Zheng, J. W., Mai, H. M., Zhang, L., Wang, Y. A., Fan, X. D., Su, L. X., Qin, Z. P., Yang, Y. W., Jiang, Y. H., Zhao, Y. F., & Suen, J. Y. (2013). Guidelines for the treatment of head and neck venous malformations. International journal of clinical and experimental medicine, 6(5), 377–389.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Guilherme Farias Apolonio, Antônio Roberto Garcia Júnior, Carina Domaneschi, Celso Augusto Lemos Júnior, Paulo Sergio Pina, Camilla Vieira Esteves
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
