What are the other Names for this Condition? (Also known as/Synonyms)

• Benign Hemangioendothelioma of Salivary Gland
• Immature Capillary Hemangioma of Salivary Gland
• Salivary Gland Haemangioma

What is Hemangioma of Salivary Gland? (Definition/Background Information)

• Hemangiomas are benign accumulations of blood vessels, which can occur in several tissues such as the brain, kidney, liver, lung, skin (cherry), and nasal cavity
• Hemangiomas of Salivary Gland are rare, benign vascular tumors, with a preference for children. Most the hemangiomas (about 65%) are found in the head and neck region. Among these, many involve the major salivary glands (chiefly the parotids)
• The cause of formation and risk factors for Salivary Gland Hemangioma (SGH) are unknown. It is believed to abnormally arise during fetal growth and development
• Most small tumors are asymptomatic and painless, though the larger ones may compress the surrounding structures and cause related signs and symptoms
• Hemangioma of Salivary Gland may be diagnosed by evaluating the clinical history and a thorough physical exam, followed by imaging studies, such as CT and MRI scans of the head and neck region
• The treatment techniques for Salivary Gland Hemangiomas may include cryotherapy, use of sclerosing solutions, and removal of the tumor through endoscopic surgery. The prognosis of Hemangioma of Salivary Gland is good with appropriate treatment

Who gets Hemangioma of Salivary Gland? (Age and Sex Distribution)

• Salivary Gland Hemangiomas constitute about 1.5% of all tumors affecting the salivary glands
• The tumor can be present in adults and children of a wide age range; a congenital presentation is also observed. Approximately 65% of the cases are seen before age 20 years
• A predilection for children is noted; a hemangioma is the most commonly noted tumor of the salivary glands affecting children
• Both males and females are affected; some studies report a male-female ratio of 1:2
• All races and ethnic groups may be affected

What are the Risk Factors for Hemangioma of Salivary Gland? (Predisposing Factors)

• Currently, there are no known risk factors for the development of Hemangioma of Salivary Gland
• The tumor has been associated with Kasabach-Merritt syndrome (KMS) in young children

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Hemangioma of Salivary Gland? (Etiology)

• Currently, there are no identified causes for the development of Hemangioma of Salivary Gland
• Researchers believe that it could develop as a malformation during fetal development

What are the Signs and Symptoms of Hemangioma of Salivary Gland?

The signs and symptoms of Hemangioma of Salivary Gland may include:

• Presence of an enlarging tumor mass by the side of the cheek (or side of the face); hemangiomas grow slowly and generally do not present any pain
• Some tumors can grow to very large sizes; in children, a growth is usually seen up to age 5-7 years, following which the tumor generally shrinks in size
• Almost all tumors arise in the major salivary glands; i.e., the parotid glands (in 90% of the cases). The remaining are mostly located in the submandibular glands
• The tumors are typically solitary, soft, and solid (spherical or oval)
• Some hemangiomas can bleed and lead to complications
• The overlying skin may present a bluish discoloration

Large tumors may cause the following signs and symptoms:

• Difficulty in opening one’s mouth; pain while eating (pain may be felt in the mouth and face)
• Numbness of part of the face
• Dryness of mouth
• Inability to move one side of the face due to damage to the facial nerve, known as facial nerve palsy
• Facial pain

How is Hemangioma of Salivary Gland Diagnosed?

The following exams and procedures may be used in the diagnosis of Hemangioma of Salivary Gland:

• Evaluation of the individual’s medical history and a through physical examination
• Plain X-ray of the head and neck region
• Ultrasound scan of the affected salivary gland
• CT or CAT scan with contrast of the head and neck usually shows a well-defined mass. This radiological procedure creates detailed 3-dimensional images of structures inside the scanned region
• MRI scans of head and neck region: A magnetic field is used to create high-quality pictures of certain parts of the body, such as tissues, muscles, nerves, and bones. These high-quality pictures may reveal the presence of the tumor

Although the above modalities can be used to make an initial diagnosis, a tissue biopsy of the tumor is necessary to make a definitive diagnosis to begin treatment. The tissue for diagnosis can be procured in multiple different ways which include: 

• Fine needle aspiration (FNA) biopsy of the tumor: A FNA biopsy may not be helpful, because one may not be able to visualize the different morphological areas of the tumor. Hence, a FNA biopsy as a diagnostic tool has certain limitations, and an open surgical biopsy may be recommended.
• Salivary gland core biopsy of the tumor
• Salivary gland open biopsy of the tumor

Tissue biopsy:

• A tissue biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
• Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
• Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely, electron microscopic studies to assist in the diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Hemangioma of Salivary Gland?

The following complications due to Hemangioma of Salivary Gland may be observed:

• Severe emotional stress and cosmetic concerns (facial disfigurement)
• Large-sized tumors may compress adjoining tissues and structures resulting in additional complications
• Ulceration and bleeding
• Surgery to remove the tumor mass may result in facial nerve palsy (surgical complication)
• Post-surgical wound infection

How is Hemangioma of Salivary Gland Treated?

• A complete surgical excision with clear margins is the preferred mode of treatment of Hemangioma of Salivary Gland, especially in adults
• Arterial embolization of the tumor may be used to provide temporary relief from the symptoms, and reduce blood loss during ‘tumor removal’ surgical procedure
• In some children, following age 5-7 years, the hemangiomas may shrink and decrease in size. In such cases, invasive procedures may not be mandated and a ‘wait and watch’ approach may be undertaken by the healthcare provider
• The treatment options in children may include:
  • Oral medications (propranolol)
  • Cryotherapy
  • Corticosteroid treatment; both intralesional and systemic
  • Sclerosing solutions
  • YAG laser
  • Endoscopic surgery
• Radiation therapy may be planned on a case-by-case basis
• Post-operative care is important: One must maintain minimum activity levels, until the surgical wound heals
• Follow-up care with regular screening and check-ups are important

How can Hemangioma of Salivary Gland be Prevented?

• Current medical research has not established a method of preventing the formation of Hemangioma of Salivary Gland
• Regular medical screening at periodic intervals with blood tests, radiological scans, and physical examinations, for those who have already endured the tumor, are helpful

What is the Prognosis of Hemangioma of Salivary Gland? (Outcomes/Resolutions)

• The prognosis of Salivary Gland Hemangioma is typically good with adequate treatment; a full recovery is often ensured and no long-term complications are noted
• In children, a spontaneous regression may occur and surgical treatment measures may not become necessary. The progression of the tumor may be controlled through conservative therapy/medication
• Endoscopic surgery is the most reliable treatment tool to completely remove the tumor and prevent any recurrences from taking place

Additional and Relevant Useful Information for Hemangioma of Salivary Gland:

There are 3 major types of salivary glands and these include the following:

• Parotid glands, found on the sides of the face
• Submandibular glands located at the back of mouth, on both sides of the jaw
• Sublingual glands that are seen under the floor of the mouth

The salivary glands produce saliva that helps in:

• Lubricating the mouth
• Swallowing
• Protects the teeth against bacteria
• Digestion of food