Intraosseous Hemangioma of the Maxillofacial District: Clinical Analysis and Surgical Treatment in 10 Consecutive Patients

Abstract

The aims of this study are to illustrate functional and esthetic results obtained with different surgical strategies and to report a review of the relevant literature. There were 6 female patients and 4 male patients included in this study, with an average age of 35.7 years. Zygomatic bone was affected in six cases, the mandible in two cases, the medial orbital wall in one case, and the upper jaw in one case. In all 10 patients, surgery consisted of a wide excision of the intraosseous hemangioma with margins of 3 mm at least to ensure complete removal. Immediate reconstruction was carried out in 5 of the 10 patients. An analysis indicates that intraosseous hemangiomas of the maxillofacial area are rare; diagnosis can be difficult and is mainly based on computed tomography scans. Surgical excision, with previous angiography and embolization in cases of intraosseous hemangioma with a larger dimension or abnormal blood supply, is the treatment of choice.

Active surveillance for intraosseous mandibular haemangioma. Case report and literature review

“…The most frequently performed procedure is a selective embolization, followed by surgical resection [5,12,15,16]. However, this surgery may cause large osseous defect with immediate reconstruction issues [12].…”

Intraosseous ‘haemangioma’ of the zygoma: More appropriately termed a venous malformation

“…The MRI and CT characteristics of soft tissue venous malformations are well described, though little information is available about the specific features of primary intra-bony venous malformations. Most cases reported as 'intra-bony haemangioma' demonstrate features of sunburst, radiating spoke wheel, reticular or soap bubble appearance, with relatively intact cortices [2][3][4][5][8][9][10]13,14,16,17,[20][21][22][23][24][25][26]28,29,31 . The present case demonstrated a radiating spoke wheel appearance of trabeculae, consistent with the features of an intraosseous 'haemangioma' and did not reveal any soft tissue involvement.…”

“…In the present case, a decision was made to remove the lesion due to its increasing size and cosmetic deformity. Though various therapeutic options have been described for soft tissue venous malformations, surgical excision remains the mainstay for purely intra-bony lesions, if necessary, augmented with preoperative embolisation [2][3][4][5][8][9][10]13,14,16,17,[20][21][22][23][24][25][26]28,29,31 . There have been no reports of recurrence or increased intra-operative bleeding when these lesions have been removed en-bloc with a margin of normal tissue but they have occurred with curettage and partial excision 2,5,23,25 .…”

“…Involvement of the facial skeleton is uncommon with the mandible and maxilla most frequently involved 27,30 . Intraosseous lesions involving the zygoma are uncommon with only 33 cases reported in the literature [2][3][4][5][8][9][10]13,14,16,17,[20][21][22][23][24][25][26]28,29,31 . These have often been described as 'haemangioma' with little attempt to clarify the specific subtype of the vascular lesion.…”

Microvascular bone grafting: A new long-term solution for intraosseous arteriovenous malformations of the mandible in children

“…Various surgical and non-surgical treatment options have been described regarding AVMs, including simple curettage, ligation of the feeding vessels, resection, radiotherapy, cryotherapy, sclerosing injections, and various forms of embolization (Motamedi et al, 2000;Kaneko et al, 2001). The gold standard treatment of AVMs is an endovascular embolization, combined with surgery (Ozdemir et al, 2002;Perugini et al, 2004). Embolization occludes the feeding vessels and decreases the blood flow of the lesion.…”