Anesthetic and Airway Management in a Case of Surgical Excision of Recurrent Buccal Hemangioma.

Difficult airway is one of the challenges trained anesthesiologists face in their life. Induction of general anesthesia in a patient with a compromised airway has always caused a dilemma for anesthesiologists. Challenges were more in this case of buccal hemangioma as its bleeding tendency makes it a challenging job. Hemangioma is a benign vascular anomaly characterized by rapid endothelial cell proliferation. It appears within the first eight weeks of life, rapidly proliferates between the ages of six and 12 months, and progressively involutes between the ages of nine and 12 years. Hemangiomas are more common in women, with a male-to-female ratio of 1:3 to 1:5. By the age of nine years, over 80%-90% of hemangiomas have completely involuted. The remaining 10%-20% involute incompletely, necessitating post-adolescent ablative treatment or alternative management options. Hemangiomas in the head and neck region account for 50%-60% of all hemangiomas. Intra-orally, the lips, buccal mucosa, and tongue are the most prevalent sites of involvement. Here, we report a case of recurrent left-sided buccal hemangioma in a 20-year-old female patient. Treatment options available to manage hemangioma include cryotherapy, laser ablation therapy, radiotherapy, sclerotherapy, and selective embolization. After prophylactic embolization of feeder vessels, surgically excising the lesion is the modality of choice. So from a general anesthesia management point of view, buccal hemangioma poses multiple challenges including difficulty in mask ventilation, difficulty in intubation, bleeding, and pulmonary aspiration.