Lobular Capillary Hemangioma of Head and Neck Region: A Retrospective Study in A Tertiary Centre

skin and mucosa of oral cavity, however, the nasal cavity involvement is very rare pertaining to head and neck vascular lesions. Here, we have retrospectively analyzed the confirmed LCH cases including sites, clinical features, radiological findings, treatments, and histological results. Materials and Methods: A retrospective study carried out in Department of Ear, Nose and Throat and Head and Neck Surgeries (ENT-HNS) of Universal College of Medical Sciences, Tribhuvan University Teaching Hospital (UCMS, TUTH), Bhairahawa, Nepal. All the data of 10 cases (from June 2014 to February 2020) were collected from the OT (operation theatre) register and hospital records section. Data were analyzed for symptoms, possible etiologic factors, demographic profile, CT findings, histopathological features, and treatment modalities. Results: Unilateral nasal obstruction with nasal mass and intermittent epistaxis (90%) were the chief complaints. Female predominance was favored. In 80% of the patients, the mass was arising from the anterior nasal septum, in 10% from the anterior end of the inferior turbinate and in 10% from the upper lip. GA (general anesthesia) was used in 20% of cases whereas LA (local anesthesia) was used in 80% of the cases. All patients were managed successfully with no recurrence at follow up of 6 months. Conclusion: It is a rare benign vascular entity with slight female predominance. It bears a less morbidity and recurrences on surgical excision but should be differentially diagnosed rightly so as to minimize aggressive management.


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. The exact pathogenesis seems to be debatable but it's linked with microtrauma (nose picking or nasal packing resulting in the overgrowth of granulation tissue) and hormonal factors such as pregnancy and oral contraceptive use as possible etiologies and other plausible being viral oncogenes, microscopic arterial venous malformations and over production of angiogenic growth factors [3][4][5][6][7]. Patients usually present with painless intermittent epistaxis, progressive unilateral nasal obstruction, and nasal mass of a short period. There's equal distribution between men and women in all ages however some studies show female predilection in the third to fifth decades [7,8,[12][13][14]. The aim of this retrospective study is to analyze the clinical presentation, histological and radiological findings, and the treatment strategy.

Materials and Methods
This is a retrospective study carried out in Department of

Inclusion Criteria
All patients with confirmed HPE (histopathology evaluation) of LCH of the nose.

Exclusion Criteria
Patients with bleeding diathesis, and other comorbidities.
Information regarding symptoms, possible etiologic factors, demographic profile, CT findings, histopathological features, and treatment modalities were reviewed. All the cases were done in the OT using either general or local anesthesia. All cases underwent surgical excision and electrocauterization of the base and sent for histopathological evaluation. Zero-degree rigid endoscopy was used in 3 cases and headlight was used in 7 cases. After the anesthetization of the case, 5 ml of 2% Xylocaine with 1:200000 Adrenaline was locally infiltrated. Ribbon gauze packs impregnated with Oxymetazoline nasal drops and 5ml of 4% Xylocaine were kept for 10 minutes then the procedure was performed. Soframycin ointment impregnated ribbon gauze pack were kept for 1 day unilaterally. Patients were discharged on the same day on oral Ciprofloxacin and analgesics. On next day, the nasal pack was removed in the OPD and topical Mupirocin ointment was prescribed for 2 weeks.

Results
There were total of 10 cases. 2 (20%) were male and 8 (80%) female patients (table 1) with male to female ratio of 1:4. The mean age was 30.6 years, ranging from 18 to 57 (Table 1) 1 male and 3 females were in the 5th decade. 2 female patients had a history of oral contraceptives intake. 1 male and 4 females had history of frequent nose picking habit. In 9 patients, the chief complaints were unilateral rapidly growing nasal mass, intermittent epistaxis and nasal obstruction and rhinorrhea in 1 patient. In 1 male patient (18 years old) the complaint was rapidly growing painless growth in the upper lip. In 1 female patient in the 5the decade the mass was arising from the inferior turbinate (left side) (Figures 1-6) and the rest being from the anterior end of nasal septum (6 on the right side and 2 on the left). The mean duration of symptoms was 2-3 months in the majority however 1 female patient in the 5th decade was having for 6-8th months and 1 male patient had it since childhood ( Table 1). Endoscopic removal was used in 3 cases and 7 were dealt with headlight. On examination, the mass ranges from 1.5 -2.5 cm in size and was single dark red to polypoidal which bleed easily on brisk touch by the instrument. CT was suggestive of well-defined, enhancing soft tissue density lesions without bony erosions. Maxillary mucosal thickening (ipsilateral) was found in 1 patient (13.3%). There were no postoperative complications with 1 recurrence case who lost to follow up till date (Table 1).
Histopathology showed section of ulceration and granulation with underlying stroma of increased proliferation of small calibered         [15]. No malignant transformation has been reported till date in these kinds of benign tumors [7]. As per the literature, LCH is predominant in females and most commonly occur in the third decade of life [5]. In our series, although two-thirds of the patients were female, supports the idea of higher incidence in the third decade (60%). The mean age was 30.6 years, ranging from females had history of frequent nose picking habit. In 9 patients, the chief complaints were unilateral rapidly growing nasal mass,

Conclusion
LCH is quite a rare benign entity in the nasal cavity region. There is a female predominance with debatable etiology and usually the presenting symptoms are unilateral progressive nasal obstruction and epistaxis of shorter duration. Keeping the differential diagnoses in mind, surgical excision is the definitive treatment modality with less recurrences and minimal morbidity. Awareness of such lesions may help in misdiagnoses of more aggressive entities.

Conflicts of Interest
The authors declare they have no potential conflicts of interest.