Figure 4(A-H).

Direct puncture sclerotherapy of tongue base slow flow vascular malformation. A 21-year-old female with a large slow flow vascular malformation of the tongue base presented with dysphagia and difficulty in speech. (A) Axial, (B) Sagittal T2W images shows a hyperintense lesion (arrow) in the base of tongue causing marked narrowing of oropharynx (arrow head). (C) Arterial, (D) Venous phase of Lingual artery (arrow) angiogram shows progressively increasing and persistent vascular blush in the lesion (arrow) – suggestive of slow flow vascular malformation. Direct puncture sclerotherapy was performed through percutaneous (E) under sonographic guidance and transoral (F) route (Black arrow) using STS. Using expandable suspending laryngoscope, the base of tongue can be optimally visualized and direct puncture of the lesion can be performed by transoral route. (G) Axial, (H) Sagittal fat suppressed contrast T1W images done after 6 weeks shows significant reduction in the size and enhancement of residual malformation (arrow) with good clinical improvement in symptoms