An unusual presentation of intramasseteric vascular malformation

Abstract

Vascular malformations (VMs) are congenital anomalies of the capillary, venous, lymphatic, and arterial system. They may be distinguished from vasoproliferative tumors (hemangiomas) which present with increased endothelial cell turnover, whereas VMs are structural anomalies of vessels without endothelial cell proliferation. VMs, in general, occur in superficial areas such as lips, tongue, and buccal mucosa, and an intramuscular location is quite rare. An intra-massetric location may be mistaken for a parotid swelling and may also pose problems in terms of proximity to facial nerve. One such rare case of intra-massetric VM occurring in a 23-year-old female with an unusual clinical presentation is being presented in this case report. The patient complained of a swelling associated with pain on her right cheek since 9 months. The swelling develops only when her head and torso is bent to 90° or more for at least 5-10 min and gradually disappears on attaining an upright posture (turkey wattle sign). Color Doppler ultrasonographic findings were suggestive of a VM. The lesion was excised under general anesthesia and was sent for histopathologic evaluation which was suggestive of an intramuscular hemangioma/ malformation. The patient did not develop any post-operative complications and had recovered well after the surgery.