Intraosseous venous malformation of the zygomatico-orbital complex. Case report and literature review with focus on confusions in vascular lesion terms

Abstract

Intraosseous vascular malformations (VascM) of the facial skeleton are rare entities, raising difficulties even today in their treatment. We present a case for zygomatic intraosseous venous malformation of traumatic etiology with growth dynamics presentation and a multidisciplinary treatment approach, with intravascular embolization surgical ablation and primary reconstructruction using a titanium patient-specific implant (PSI), and a review of the literature for intraosseous vascular lesions of the facial skeleton focusing on the diagnostic syntagms used by the involved medical personnel, to shed light on the confusions over these terms.

Intraosseous Venous Malformation of the Zygomatic Bone: Comparison between Virtual Surgical Planning and Standard Surgery with Review of the Literature

“…Although the most frequently reported complication in the literature was intraoperative bleeding, only one case [ 4 ] out of 64 presented with a venous malformation. In our case series, it was not evident in any of the patients.…”

“…On the contrary, vascular malformations are lesions resulting from the remainder of vascular embryological tissue, which has progressive growth without involution and may be affected by hormonal factors, such as puberty or pregnancy, undergoing accelerated growth under these circumstances [ 4 , 21 , 22 ]. Within them, venous malformations represent the most frequent peripheral vascular malformation [ 23 ].…”

“…Most of the articles about vascular malformation affecting the zygomatic bone did not present an immunohistological justification for the diagnosis provided, so it is impossible to specify whether they were really intraosseous hemangiomas, venous malformations or other vascular malformations. Moreover, before 1982, it is common to find allusions to “arteriovenous malformation” as a synonym for hemangioma [ 4 ]. Even so, there are much more recent publications with this terminology that lead to error and several articles have even been obtained in which the pathological outcome differs from the title of the manuscript.…”

“…Even so, there are much more recent publications with this terminology that lead to error and several articles have even been obtained in which the pathological outcome differs from the title of the manuscript. It is noteworthy that despite having the binary classification since 1982, it took 7 years to find the first case published [ 4 , 17 ]. Before 1996, more than 90% of cases were presented as intraosseous hemangioma.…”

“…Contemplating the range of therapeutic options for these types of injuries in the literature, multidisciplinary management is considered the gold standard [ 4 , 32 ]. Surveillance may be an option in asymptomatic cases [ 33 ].…”