A 61-year-old man presented to our service with an asymptomatic lingual tumor of several weeks duration.
Physical examination revealed a non-ulcerated, painful, hard lingual mass occupying the right anterior portion of the tongue, without crossing the midline.
The patient had no functional disorders and the cervical examination was anodyne.
Initial MRI showed a submucosal lesion of the anterior portion of the right free tongue measuring about 3 cm in diameter.
FNAB suggested a diagnosis of glomic tumor.
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The patient underwent surgery under general anesthesia (October 1992), performing block resection of the lesion, with important hemostatic measures.
It was not necessary to use complex reconstructive techniques, and the postoperative course was uneventful.
The AP report indicated a lesion composed of vascular structures with prominent cells distributed as nodules separated by sclerotic bands.
Numerous vascular elements of thin endothelium without cellular atypia or mitosis were identified, with a final diagnosis of glomus tumor.
The patient was monitored on an outpatient basis during an annual visit, with no signs of recurrence.
Seven years after the first intervention, the patient presented with a new lingual tumor, in this case associated with pain in the mandibular symphysis.
The examination showed an injury that crossed the midline and affected the floor of the mouth, with ankyloglossia.
Significant mobility was observed in the anterior area of the mandible, with severe pain in response to dental mobilization.
Orthopantomography showed a lytic lesion between the first right premolar and the second left molar, together with an interincisal pathological fracture
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Half of them showed lesions with the same vascular characteristics of 7x4.5cms affecting the right hemilingual, anterior sector of the left hemilingual, floor of mouth, right submaxillary space, blastic mandibular connection.
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Before surgery, an arteriography showed an impoverished hypertrophy of both submental branches of the facial arteries and hypertrophy of the inferior alveolar arteries, which formed an important vascular expansive lesion
It was decided to embolize the lesion to ensure vascular control.
A previous tracheostomy was performed to prevent possible airway obstruction secondary to facial swelling after embolization.
Different embolization sessions were carried out that did not allow to control the evolution of the lesion.
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The impossibility of a combined embolization-surgery treatment was decided to administer radiotherapy with the pin to control the size of the lesion.
During this period the patient suffered multiple episodes of minor bleeding that resolved with local hemostatic measures.
Pain was controlled with oral analgesia, and the patient presented significant speech and language disorders.
