Buccal vascular malformation with multiple giant phleboliths: a rare case presentation and review of the literature

A Peculiar Finding on the Ventrolateral Surface of the Tongue

Phleboliths are reported as calcifications that occur in vascular malformations, associated with changes in blood flow dynamics, thrombus formation and subsequent calcifications. Radiological examination, such as cone beam computed tomography (CBCT) could help in demonstrating the presence of a calcifiied mass. A 45-year-old male was referred to our service with an asymptomatic nodular purplish lesion located on the ventrolateral tongue. Within the lesion, a stony mass was also evident on palpation. A digital dental radiograph demonstrated two circumscribed radiopaque structures. Phleboliths associated with vascular malformation was the main diagnostic hypothesis. The patient underwent a sclerotherapy protocol allowing surgical accessibility to the area. Phlebolyts were surgically removed using electrocoagulation. Histopathological examination revealed phleboliths in the context of a vascular malformation with intense fibrosis.

Unusual Number of Phleboliths in a Lip Vascular Malformation - A Case Report

Rationale

Vascular malformation (VM) associated with jaws may cause jaw size discrepancy. Multiple phleboliths in VM are relatively rare. This case report aims to present one such case.

Patient Concerns

A 33-year-old female patient sought surgical correction of her abnormally sized jaw and on examination, she was identified with VM.

Diagnosis

Subsequent imaging tests revealed the presence of several phleboliths.

Treatment

The patient was treated for an abnormal-sized mandible as well as partial removal of the superficial part of VM.

Outcomes

The patient had satisfactory esthetics and there was less bleeding than anticipated.

Take-away Lessons

VMs could cause jaw size discrepancy and the extent of the malformation could cause blood flow abnormalities leading to multiple phlebolith formation. Proper surgical planning and education of the patient are essential for successful treatment.

[Flebolites in the maxillofacial region: a challenge for imaging diagnosis. A review]

Vascular alterations or disorders of the blood and / or lymphatic vessels have their own characteristics, the identification of calcifications being a correct parameter to be able to make a proper diagnosis. The objective of the study was to describe the radiographic characteristics of the phleboliths, and whether they represent a challenge for diagnosis. according to the literature reviewed in the Medline (PubMed) database, Scielo, Google Scholar and some specialized journals. Phleboliths were found to have very particular radiographic characteristics, with concentric radiolucent and radiopaque images that resemble rings. However, not all the presentations are similar, this makes the diagnosis misleading with other calcifications in this region, such as sialoliths where their appearance is usually similar. Furthermore, there is the relationship with vascular anomalies and hemangiomas. finally, the evidence points to very specific characteristics of this lesion, and it is necessary to individualize each case, due to the differences that exist from one patient to another.