A case of venous malformation of the mandible

Central vascular malformations of the mandible: Characteristic findings in computed tomography and magnetic resonance imaging

Central vascular malformations (CVMs) of the mandible are rare and can have varied clinical and radiological characteristics, thus making differential diagnosis difficult. We retrospectively reviewed 5 patients with proven CVM who underwent computed tomography (CT) and magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) (and magnetic resonance angiography (MRA) for one patient), to assess the characteristic imaging findings of this lesion. CT revealed multilocularity in 3 lesions. All CVMs produced fine, irregular borders and low-to-intermediate density. Lesion continuity with the mandibular canal was discovered in 4 cases and enlarged feeding and outflow vessels in 3 lesions. Bone overgrowth was observed in 2 patients. CT values ranged from 30.84 to 52.87 Hounsfield units (HU). MRI exhibited low to intermediate signals on T1-weighted imaging (T1WI), signals ranging from low to intermediate-to-high on T2WI, and low to high signal intensity on short-tau inversion recovery (STIR) images, with flow voids in all patients and no inflammation in surrounding tissues. As calculated with DWI, the apparent diffusion coefficient (ADC) ranged from 0.69 to 1.74 × 10^-3 mm²/s. MRA showed the presence of feeding vessels in 1 lesion. Interexaminer agreement on image interpretation ranged from moderate to excellent. These typical CVM imaging findings may aid in the differential diagnosis of this lesion.

Angiographic Embolization with Histoacryl in Combination with Direct Injection of Bone Cement of an Intraosseous Venous Malformation of the Mandible: Report of a Case with 22-Year Follow-Up

Vascular malformations of the maxillofacial region are unusual, and they occur more rarely in bone than in soft tissue. Mandibular intraosseous vascular lesions represent 0.5-1.0% of all bone tumors, and they are classified as venous malformation, lymphatic malformation, arterial malformation, arteriovenous malformations, and arteriovenous fistulae. Venous malformation is the most common vascular malformation, accounting for 44-64% of all vascular malformations, and is considered a low-flow malformation. Endovascular therapy as selective angiographic embolization is considered as the first-choice treatment associated or not with emboli injections with a success rate of 70%, and this evades mutilating surgery and related sequelae. We report a case of mandibular venous malformation on a 45-year-old female complaining of unilateral swelling of the left body of the mandible with facial deformation. The computed tomography scan images and the T1-weighted MR images showed a lesion that expresses an expansible lesion in the spongy bone of the left of the mandible with a buccal cortical rupture. Signal voids were not identified, suggesting a low-flow vascular lesion. The T2-weighted images exposed hypersignals; accordingly, a vascular lesion was suspected. The treatment was done under locoregional analgesia; after selective angiography, direct histoacryl injection was completed, followed by bone cement injection. The patient was followed yearly since1998. Radiological images of 10-year follow-up MRI showed a stabilization of the lesion without any new extensions. The panoramic radiograph after 22 years showed a bone formation inside the body of the mandible. The long follow-up period and the absence of any complications are favorable for the adopted treatment plan.

A Case of Multiple Phleboliths on the Medial Side of the Right Mandible

A 66-year-old female patient was admitted to the orthopedic department due to a left femoral neck fracture. She received perioperative oral management prior to femoral head replacement. Laboratory blood tests indicated an elevated D-dimer level, which suggested the presence of a venous malformation. Computed tomography, magnetic resonance imaging, and short TI inversion recovery indicated the presence of multiple phleboliths medial to the right mandibular ramus. No swelling, redness, or salivary colic pain was observed. Owing to the absence of clinical symptoms, the patient elected to undergo observation of the lesion, as opposed to surgical treatment.

An unusual presentation of intraosseous malignant peripheral nerve sheath tumour of mandible

Malignant peripheral nerve sheath tumour (MPNST) is a rare mesenchymal tumour which usually presents high grade malignancy. We report an atypical case of intraosseous malignant peripheral nerve sheath tumour on mandible in a 36-year-old male. Patient presented with an incidentally discovered radiolucency on the left anterior mandible and did not complain of any symptoms. Panoramic radiograph and computed tomography showed enlargement of inferior alveolar nerve canal, thinning of the cortex and calcified foci within an expansile mass. Magnetic resonance images revealed heterogeneous hyperintense signal intensity with a well-defined margin on T₂ weighted images, heterogeneous enhancement on contrast-enhanced T₁ weighted images and intermediate signal intensity and inferior alveolar nerve canal enlargement on T₁ weighted images. In spite of benign radiologic characteristics as mentioned above, histopathologic examination of biopsied specimen otherwise revealed a low-grade malignancy. Wide excision of mandible was performed and there has been no loco-regional recurrence or distant metastasis over 1 year following surgery. This case indicates that, even when imaging modalities clearly demonstrate benign nature of intraosseous neurogenic tumour, care must be taken to establish proper treatment plan for assumed malignancy with a definitive histopathological analysis.