Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology xxx (xxxx) xxx–xxx

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Journal of Oral and Maxillofacial Surgery, Medicine, and

Pathology
journal homepage: www.elsevier.com/locate/jomsmp

Technical note

Use of 5% monoethanolamine oleate foam in oral varicose

⁎
Camila de Nazaré Alves de Oliveira Katoa, , Márcio Bruno Figueiredo do Amaralb,
Wagner Henriques de Castroa, Ricardo Santiago Gomeza, Ricardo Alves Mesquitaa
a
Department of the Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Pampulha, 31270-901, Belo
Horizonte, MG, Brazil
b
Department of Oral and Maxillofacial Surgery - Hospital João XXIII/FHEMIG, 400 Alfredo Balena Ave, Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil

A R T I C LE I N FO A B S T R A C T

Keywords: Objective: Oral varicose is an acquired change that occurs in the veins. Usually, small oral varicose require no
Foam sclerotherapy treatment. Aesthetic site, trauma and bleeding risk of the lesion need of intervention. This technical note de-
Monoethanolamine oleate scribes the treatment of oral varicose by sclerotherapy in form of foam.
Oral varicose Method: The 5% monoethanolamine oleate was used. The foam was produced with Tessari method, in which the
Treatment
proportion air:liquid sclerosing was 4:1. A single application of the 0.5 mL of foam was made under local an-
esthesia.
Result: Signs and symptoms were minimal after the treatment. Clinical remission of the lesion was observed in
two weeks.
Conclusion: The 5% monoethanolamine oleate foam showed to be effective and safety for treatment this case of
the oral varicose.

1. Introduction monoethanolamine oleate foam. The procedure used four 10 mL syr-

Oral varicose is an acquired change that occurs in the veins. In the
sublingual region of older people are conditions common, but may
occur in other regions of the buccal mucosa [1]. Usually, small oral
varicose require no treatment. Aesthetic site, trauma and bleeding risk
of the lesion need of intervention. Surgical removal, photocoagulation
by laser and use of sclerosing agents are the main indications of treat-
ment. In this technical note, we present the treatment of a varicose in
the buccal mucosa by sclerotherapy with 5% monoethanolamine oleate
foam.
2. Method
The oral varicose was localized on the right side of the buccal mu-
cosa near the occlusal line as shows the Fig. 1. The oral varicose
measured about 10 × 10 mm and was associated with trauma in the last
few months according to the patient. Diascopic examination with a
glass slide resulted in blanching of the lesion. The clinical diagnosis was
of oral varicose.
The treatment proposed was sclerotherapy with 5%
inges with needles (Injex®, Indústria Cirúrgicas Ltda, São Paulo, Brazil),
one 27-gauge (Lamedid®, São Paulo, Brazil), one anesthetic bottle 2%
lidocaine without vasoconstrictor (Xylestesin®, Cristália, São Paulo,
Brazil), one three-way tap (Embramed®, São Paulo, Brazil) and one
2 mL ampule of 5% monoethanolamine oleate (Ethamolin®, Zest
Farmacêutica Ltda, Rio de Janeiro, Brazil). Sclerosing foam was pro-
duced using the Tessari method [2] (Fig. 2). Using this method, 2 mL of
5% monoethanolamine oleate was drawn into a 10 mL syringe and 8 mL
of air was drawn into another syringe; the two syringes were connected
to a three-way tap and the plungers of both syringes were moved back
and forth 20 times to produce sclerosing foam (Fig. 2B and C). Local
anesthetic (1 mL) was injected in two locations near the lesion. The
anesthetic was injected via a gauge connected with another 10 mL
syringe to improve procedure time. The anesthetic syringe was replaced
with an empty syringe to puncture the lesion. A single puncture was
necessary. The foam in the syringe was positioned in the same gauge
and slowly injected intraluminally; a single application of 0.5 mL of
foam was injected.
Immediately after the application, there was local ischemia and
oedema. These symptoms remained for about 2 days. There was no

⁎
Corresponding author at: Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Faculdade de Odontologia, sala
3202D, Av. Antônio Carlos 6627, Pampulha, 31270-901, Belo Horizonte, MG, Brazil.
E-mail addresses: cnao20@yahoo.com.br (C.d.N.A.d.O. Kato), marciobrunoamaral@yahoo.com.br (M.B.F.d. Amaral),
wagnerhcastro@hotmail.com (W.H.d. Castro), rsgomez@ufmg.br (R.S. Gomez), ramesquita@ufmg.br (R.A. Mesquita).

https://doi.org/10.1016/j.ajoms.2018.08.010
Received 9 May 2018; Received in revised form 7 August 2018; Accepted 30 August 2018
2212-5558/ © 2018 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd All rights reserved.

Please cite this article as: Kato, C.d.N.A.d.O., Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology,
https://doi.org/10.1016/j.ajoms.2018.08.010
C.d.N.A.d.O. Kato et al. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology xxx (xxxx) xxx–xxx

Fig. 1. Oral varicose: red purple nodule in the right buccal mucosa measured about 10 x 10 mm. (For interpretation of the references to colour in this figure legend,
the reader is referred to the web version of this article.)

Fig. 2. Tessari method for foam preparation. Material used (A). The two syringes were connected to a three-way tap. The proportion was of 2 ml of 5% mono-
ethanolamine oleate for 8 ml of air, in the 4:1 proportion. The arrows (yellow and red) indicate the direction of the movements of plungers of both syringes by 20
times to produce foam (B) and the ready foam (C). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this
article.)

necrosis, bleeding, burning sensation, hematoma, paresthesia, infection
or pain. Two weeks after the application of foam, the lesion had clinical
remission and fibrosis was not observed (Fig. 3). The patient was fol-
lowed up for 2 years; no recurrence was observed.
3. Discussion
Oral varicose is acquired vascular anomaly that represents ex-
tremely dilated local dermal or submucosal veins. These conditions
often occur in adults and the prevalence of varicose increases with age.
Varicosities are described as typical findings in the sublingual regions of
older people [1]. Oral varicose may occur in the oral mucosa, such as
the lips and buccal mucosa, and are usually asymptomatic [3].
This technique is easy to apply, no complications for patient and it
has a low cost. Different sclerosing agents have been used to treat oral
varicose, including sodium tetradecyl sulfate, n-butyl cyanoacrylate,
ethanol and polidocanol [4]. The polidocanol foam was effective in the
treatment of low flow vascular malformations of oral cavity with low
morbidity [5]. The Tessari method recommends one part of the
sclerosing solution to four parts air [2]. The repeated mixing process of
liquid and air produces foam which appears to have greater sclerosing
effect than the liquid form, since it is possible to increase drug contact
with the vessel wall [4]. In addition, the microbubbles formed in this
process are easily eliminated by body without side effects. Sclerosing
foam fills the target vein, displacing the blood and allowing for longer.
The prolonged contact of the drug with the endothelium causes damage
to the vessel, and ablation of the vein [2]. The novelty of this paper is
the successful treatment of vascular anomaly in the oral region with 5%
monoethanolamine oleate used in the foam form in the unique session.
In dentistry, 5% monoethanolamine oleate sclerotherapy is well known
in the liquid form and usually more than one application of the liquid
drug may be required for clinical complete remission of the lesion [6],
possibly due decreased drug's contact with the anomaly caused by the
ease of drug delivery within the tissues. The 5% monoethanolamine
oleate foam showed effectiveness and safety treatment in this case of
oral varicose with unique session. However, an accurate clinical diag-
nosis of the varicose is necessary, as well as careful selection in the site
and size of the lesions to be treated.

2
C.d.N.A.d.O. Kato et al. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology xxx (xxxx) xxx–xxx

Fig. 3. Two weeks post treatment with 5% monoethanolamine oleate foam. It is observed remission clinical of oral varicose.

Ethical approval 2015;32:82–9.

[2] Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in
the treatment of varicose veins. Dermatol Surg 2001;27:58–60.
This procedure was undertaken after approval from the ethical [3] Azevedo LH, Del Vechio A, Nakajima E, Galletto V, Migliari DA. Lip and oral venous
committee of the institute and appropriate informed consent was ob- varices treated by photocoagulation with high-intensity diode laser. Quintessence Int
tained from the patient. (Berl) 2013;44:171–4.
[4] Talens Ferrando A, Ferrer Mengual S, et al. Alcohol sclerotherapy to treat vascular
malformations in the oral cavity. Radiologia 2013;55:514–22.
Conflict of interest [5] Gómez EG, Barrero MV, Caballero ML, Pérez SB, Navarro JMC, Plasencia DP, et al.
Sclerotherapy of face and oral cavity low flow vascular malformations: our experi-
ence. Br J Oral Maxillofac Surg 2014;52:43–7.
None of the authors has any conflict of interest, financial or other- [6] Johann AC, Aguiar MC, Carmo MA, Gomez RS, Castro WH, Mesquita RA.
wise. Sclerotherapy of benign oral vascular lesion with ethanolamine oleate: An open
clinical trial with 30 lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2005;100:570–84.
References

[1] Lazos JP, Piemonte ED, Panico RL. Oral varix: a review. Gerodontology