Images in Clinical Practice

Indian Pediatrics 2002; 39:693-694

Palatal Hemangioma With Cleft Zero

A term female newborn weighing 2.7 kg presented immediately after birth with respiratory distress. The baby had tachypnea with chest retractions with no auscultatory abnormality. Cardiovascular and abdominal examinations were normal. Oral cavity showed a large reddish-white, firm midline mass arising from hard palate (Fig.1) measuring 2.5 cm in diameter. It blanched with pressure and this was associated with subsurface midline cleft lip (Fig.2) and cleft palate.

Fig. 1. Oral cavity showing the reddish-white, firm midline mass arising from the hard palate.

Chest x-ray was normal. CT scan of head showed no connection of the mass with the intracranial structures. FNAC done on the mass showed only blood.

A clinical diagnosis of capillary hemangioma of palate with cleft zero was made and the baby was treated with supportive measures and intralesional steroids. Respiratory distress improved and size of the hemangioma reduced over the next two weeks.

Fig. 2. Note the subsurface midline cleft lip.

Hemangiomas are the commonest benign tumors of the head and neck in children. However, they are extremely rare on the palate. Juvenile capillary hemangiomas present as bright red or purple lobulated lesions with well defined margins. They are rubbery in texture and blanch with pressure. Medical treatments that have been used successfully for juvenile capillary hemangioma include systemic steroids and interferon. Surgical modalities include intralesional steroid injection, cryotherapy, sclerotherapy, laser therapy and excision.

Any midline deformity of face is called by some workers as cleft zero. Subsurface cleft palate occurs due to non-fusion of mesodermal elements of the palatine process, which manifests as mere palate with mucoperiosteum with no muscle element in the center. They need complete palatal repair even though there is skin continuity. Association of capillary hemangioma with cleft zero is very rare.