Dental management of intraoral vascular malformation in a 3.5-year-old child: case report and brief review

Abstract

BackgroundCongenital vascular malformations in the oral and maxillofacial region present significant diagnostic and therapeutic challenges, particularly in pediatric patients. These lesions-most commonly low-flow venous malformations-can compromise oral function, aesthetics, and routine dental care due to their vascular nature and bleeding risk.Case presentationWe report the case of a 3.5-year-old girl with a congenital vascular malformation involving the left cheek, upper lip, vestibule, hard palate, soft palate, and anterior maxilla. The lesion was present at birth and gradually enlarged. Magnetic resonance imaging (MRI) confirmed a low-flow venous malformation; biopsy was avoided due to hemorrhagic risk. The patient had previously undergone intralesional bleomycin injections and laser therapy abroad. Dental treatment was performed in Iran under challenging conditions due to limited cooperation and proximity of the lesion to treatment sites. Despite these limitations, pulpotomy and stainless-steel crown placement were successfully completed without sedation or general anesthesia. Two anterior tooth was extracted during the follow-up period without complications. Preventive care included fluoride therapy every three months, application of a milk-derived remineralizing agent containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and use of silver diamine fluoride (SDF) for the lower right lateral incisor. Notably, the patient's dietary habits improved significantly following dental intervention.ConclusionThis case underscores the importance of individualized, comprehensive, and minimally invasive dental management in children with vascular anomalies. Imaging-based diagnosis and interdisciplinary collaboration are essential to avoid invasive procedures and ensure safe, effective outcomes. Preventive strategies and behavioral improvements following dental care further emphasize the holistic impact of tailored treatment approaches in pediatric patients with complex medical conditions.