Hemangiomas of the head and neck with phleboliths: Clinical features, diagnostic imaging, and treatment of 3 cases

Hemangioma - A Rare Cause of Laryngeal Growth in an Adult and its Management with Sclerotherapy and Laser Surgery: A Case Report

Hemangiomas are benign tumors of vascular origin commonly affecting head and neck region. Laryngeal Hemangiomas are however rare and have no well-defined management protocols. We present an interesting case of a 42-year-old adult who was diagnosed as a case of Laryngeal Hemangioma based on clinical and radiological findings and was managed with local injection of sclerosing agent followed by CO2 Laser fulguration. The patient had a satisfactory outcome and remains asymptomatic.

[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.

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

PURPOSE

The purpose of this study was to describe a case and to review the diameters, symptoms, locations, and treatment methods for vascular malformations (VMs) with phleboliths. Our case report is probably the first to mention this observation because of sizes and large number of phleboliths in buccal region.

CASE PRESENTATION

A 26-year-old male patient was referred to Ordu University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery for the evaluation and management of a painless tender swelling in the left buccal region. Clinically, a bluish mucosal lesion of the posterior region of the left buccal mucosa and lip is apparent. Panoramic radiography and CT were obtained for radiographical examinations. Multiple giant phleboliths with the largest dimension of 32 mm were seen in this region. Left maxillary first molar teeth extraction was indicated. An aspiration was performed and revealed that there is a risk of severe hemorrhage. The patient did not want to take MRI and stated that he only wanted to have dental treatment. Therefore, it was decided that the maxillary first molar should be retained in the region and endodontic treatment should be done, if necessary.

CONCLUSIONS

The clinic of phlebolith patients is painless swelling and can reach up to 6 cm. The localization is not specific but is found in the masseter and parotid regions generally. Treatment may be invasive or non-invasive depending on, location, accessibility, depth of invasion, age, cosmetic issues, and risk of severe hemorrhage, as with the current case.

Intramuscular hemangioma in buccal cheek: a case report

Hemangioma is the most common benign tumor of a vascular origin, and is characterized by the abnormal proliferation of blood vessels. Intramuscular hemangioma (IMH) usually involves the skeletal muscles of the trunk or limbs, but rarely occurs in the head and neck region. This case report presents a patient with IMH showing multiple phleboliths in the buccal cheek. A 13-year-old boy was referred for the evaluation and management of painful swelling of the left cheek that had gradually increased in size over a 6 year duration. The examination revealed a palpable firm mass. Reddish-blue buccal mucosa color was observed with an aciniform shape. Preoperative magnetic resonance imaging (MRI) showed a vascular tumor in the left side adjacent to the buccinator and depressor orbicularis oris muscles. Surgical resection under general anesthesia was performed via the intraoral approach. The mass and phleboliths were extracted successfully. A histopathological examination confirmed the diagnosis of IMH. In conclusion, clinicians should be aware of the possibility of IMH in cases of a palpable mass with multiple nodules deep within the muscle in the buccal cheek. Among the several diagnostic tools, MRI provides essential information on the extent and surrounding anatomy of IMH.

Osteoma Cutis of the Face in CBCT Images

Osteoma cutis (OC) is a rare benign disorder where osseous nodules form in the reticular layer of normal skin. These nodules are formed by the deposition of lamellar bone and are characterized by osteocytes in the core and osteoclasts around the periphery. Interpretation of osteoma cutis cases has always been challenging especially using conventional two-dimensional (2D) radiographs, owing to difficulty in localization. Cone beam CT (CBCT), with its three-dimensional (3D) capabilities, offers a great tool to help detect and diagnose these calcific entities. We report a case of miliary type OC incidentally detected in the maxillofacial region using CBCT imaging.

Diffuse infiltrative laryngoesophageal and peritoneal venous malformations mimicking carcinomatosis with a subclavian vein aneurysm

Venous malformations are benign vascular lesions that can occur in any part of the body. Esophageal venous malformations can extend into the peritoneum, so preoperative imaging can be decisive in diagnosis and treatment. The characteristic manifestations of venous malformations are transmural phleboliths, centripetal enhancement on dynamic CT, and bluish mucosa on endoscopy. We report a rare case of female patient diagnosed with venous malformations involving laryngoesophagus, mediastinum, and peritoneum, which mimicked carcinomatosis, in addition to a left subclavian vein aneurysm.

An Isolated Phlebolith on the Lip: An Unusual Case and Review of the Literature

Background. Calcified thrombi are a common finding, especially in the pelvic veins. There are generally multiple thrombi, and they are generally associated with vascular malformations. Design. Herein we report a rare case of a single labial phlebolith, not associated with any other vascular lesion. We aim to alert clinicians to the possibility of the occurrence of vascular thrombi in the mouth and to describe the clinical and histological characteristics of such lesions in order to simplify the diagnosis and treatment. Furthermore, we have reviewed the English-language literature published since 1970 reporting oral (including masticatory muscles) phleboliths. Results. Twenty-nine cases of phleboliths have been reported in the literature since 1970. Only three of the reported phleboliths were solitary and not associated with other vascular lesions, as in the case presented here. Conclusion. Although phleboliths not associated with other vascular lesions are not common, clinicians should be aware of the existence of this pathology and include it as differential diagnosis of oral lesions.

The current approach to the diagnosis of vascular anomalies of the head and neck: A pictorial essay

Throughout the years, various classifications have evolved for the diagnosis of vascular anomalies. However, it remains difficult to classify a number of such lesions. Because all hemangiomas were previously considered to involute, if a lesion with imaging and clinical characteristics of hemangioma does not involute, then there is no subclass in which to classify such a lesion, as reported in one of our cases. The recent classification proposed by the International Society for the Study of Vascular Anomalies (ISSVA, 2014) has solved this problem by including non-involuting and partially involuting hemangioma in the classification. We present here five cases of vascular anomalies and discuss their diagnosis in accordance with the ISSVA (2014) classification. A non-involuting lesion should not always be diagnosed as a vascular malformation. A non-involuting lesion can be either a hemangioma or a vascular malformation depending upon its clinicopathologic and imaging characteristics.

Cellular infiltrative angiolipoma of cheek in an infant

Lipomas represent about 1 to 5% of all neoplasms of the oral cavity most commonly presenting as painless, mobile, soft, round mass. Angiolipoma, spindle cell lipoma, mylelolipoma, chondrolipoma and myxolipoma are histological variants of lipoma arising from fat tissues. Although the angiolipoma is the most common tumour in the trunk and the extrimities of young people, it occurs infrequently in the head and neck region. In this article we present clinical, radiological and histological features of a cellular infiltrative angiolipoma exicised from the buccal mucosa of a 9 months old female child.

Intramuscular cavernous haemangioma of masseter muscle - a case report of surgical excision

Intramuscular haemangioma are rare benign congenital neoplasm of proliferative vascular in nature due to increased endothelial cell turnover. Less than 20% of these are found in head and neck region. The masseter muscle accounts for 5% of all intramuscular haemangioma of head and neck region. They are non metastasizing tumours which may suddenly start growing in later stages. The present article will discuss the clinical presentation, diagnostic modalities and surgical treatment of cavernous Haemangioma involving masseter muscle in a 15-year-old young female patient in whom a surgical excision of whole lesion was done under general anaesthesia and no reoccurrence of the lesion was observed after one year of follow up.

Intramuscular hemangioma with phleboliths of the tongue

Intramuscular hemangioma (IMH) is relatively rare benign tumor of vascular origin. Phleboliths are calcified thrombi found in the presence of hemangioma. The main treatment of the hemangioma is a surgical extirpation based on location, accessibility, and cosmetic considerations. We herein report a rare case of IMH with phleboliths of the tongue with clinical, imaging, and histopathological findings.

Masseteric intramuscular hemangioma: case report

Securing a clinical diagnosis for the masseteric intramuscular hemangioma is difficult. However, making a diagnosis can be facilitated with imaging, particularly magnetic resonance imaging, which serves as a key element in preoperative diagnosis.

Gold-wire artifacts on diagnostic radiographs: A case report

This report described a case in which diagnostic radiographs showed irregular dense radiopaque strings and curved lines in the head and neck area. These artifacts could lead to misinterpretation since they may obscure anatomical structures and/or mask critical structures/pathologies. A more detailed history of the patient indicated that these strings originated from a facelift procedure in which a gold-wire technique was used. Considering that such intervention may cause a radiodiagnostic burden, it should be included in the anamnesis prior to radiography.

Potential of fluid-attenuated inversion recovery MRI as an alternative to contrast-enhanced MRI for oral and maxillofacial vascular malformations: experimental and clinical studies

OBJECTIVE

To determine the potential of fluid-attenuated inversion recovery (FLAIR) imaging of oral and maxillofacial vascular malformations as an alternative to contrast-enhanced magnetic resonance imaging (MRI), we investigated the influence of differences in T1 and T2 values on image contrast in FLAIR images and evaluated the diagnostic utility of such images.

STUDY DESIGN

FLAIR imaging and heavily T2-weighted (hT2-weighted) imaging were performed using a phantom. FLAIR and hT2-weighted images of 32 lesions (11 mucous cysts, 12 vascular malformations, and 9 tumors) were also studied retrospectively. The contrast-to-noise ratios (CNRs) and CNR change ratios were compared.

RESULTS

All aqueous solutions except those with a short T2 value were discriminated by CNR change ratio (P < .05). All 3 types of lesions were discriminated by CNR change ratio (P < .05).

CONCLUSION

FLAIR imaging has potential as an alternative to contrast-enhanced MRI in differentiating vascular malformations from other types of lesions in the oral and maxillofacial region.

Large arteriovenous malformation of the oromaxillofacial region with multiple phleboliths

Vascular tumors are the most common benign tumors of the head and neck in infancy and childhood. Vascular anomalies of the head and neck were divided into 2 categories including hemangiomas and vascular malformations. Oral and maxillofacial hemangiomas and vascular malformations are congenital lesions with various clinical characteristics, manifestations, indications, and possibilities for treatment. This paper reports a case of large arteriovenous malformations including a description of the features demonstrated by panoramic radiography, cone beam computed tomography, and magnetic resonance imaging. The differential diagnosis and treatment modalities (including embolization with N-butylcyanoacrylate in this case) are also discussed following the case presentation, along with the available literature review.

Surgical management of head and neck vascular anomalies in children: a retrospective analysis of 42 patients

OBJECTIVE

This article aimed to present a series of surgically treated head and neck vascular anomalies during a 12-year period, highlighting the epidemiology, diagnostic approach, indications for surgery, and final clinical outcome.

STUDY DESIGN

The medical records of all patients with head and neck vascular anomalies, surgically treated at our department from 1998 to 2010, were reviewed retrospectively.

RESULTS

A total of 42 patients with 46 vascular anomalies were identified. Patients' diagnoses included vascular tumors, hemangiomas mainly (18 cases), and various vascular malformations (26 cases). All patients were submitted to surgical treatment (excision-resection) to resolve main clinical symptoms (ulceration, bleeding, impaired mastication and feeding, airway obstruction) and/or esthetic issues. Recurrence was noted in 3 patients.

CONCLUSION

Accurate differential diagnosis based on history, physical examination, and imaging, is the key to optimal treatment. Surgical intervention is warranted for small to moderately extended lesions to avoid complications and/or esthetic concerns and psychosocial distress.

Intramuscular hemangioma presenting with multiple phleboliths: a case report

A rare case of intramuscular hemangioma of the masseter muscle with multiple phleboliths is described, highlighting features evident in plain radiography, ultrasound, and magnetic resonance imaging (MRI). A 21-year-old woman presented with a complaint of swelling of the right masseter muscle. A plain radiograph from the soft tissue of the right cheek showed a large number of round, target-like radiopacities that varied in size. Ultrasound revealed a lobulated cystic lesion in the right masseter muscle with increased echogenicity. MRI showed a space-occupying lesion in the right masseter muscle, which was isointense on T1-weighted image close to the muscle tissue and hyperintense on T2-weighted image, containing fields with no signal septations. A plain soft tissue radiograph can demonstrate phleboliths and aid in the diagnosis of an intramuscular hemangioma. In addition, nonionized techniques such as ultrasound and MRI can provide useful information to clinicians regarding the location of calcifications and the structure of masses.

Intraoral venous malformation with phleboliths

The most common type of vascular malformation is the venous malformation and these are occasionally associated with phleboliths. We report a case of a 45 year old woman with intraoral venous malformation with phleboliths.

Use of an electrosurgical scalpel in gingival overgrowth associated with Rendu-Osler-Weber syndrome

We present a case of gingival overgrowth, with aesthetic repercussions, associated with Rendu-Osler-Weber syndrome. Treatment consisted of electric gingivectomy. We noted that it is necessary to carefully monitor hemorrhaging during surgery as well as to provide a correct differential diagnosis to distinguish this syndrome from other illnesses that involve gingival growth.

Treatment of hemangioma of the head and neck with diode laser and forced dehydration with induced photocoagulation

OBJECTIVE

The aim of this study was to investigate the efficacy of treating oral hemangiomas using forced dehydration with induced photocoagulation (FDIP) via diode laser.

METHODS

One-hundred sixty patients were treated between 1999 and 2006 (76 men, 46%; 84 women, 54%). In 136 cases we used FDIP to treat hemangioma, and in 24 cases complete surgical excision was performed. One-hundred thirty-four lesions had a surface area <2 x 2 cm2, whereas only two had large lesions measuring 2.5 x 2 cm2.

RESULTS

In 136 patients with hemangiomas treated with FDIP, 134 cases (98.53%) showed complete remission, one case (0.735%) did not show complete remission, and one case (0.735%) displayed tumor growth. There were no adverse effects and all patients were carefully followed-up until complete healing was documented, along with any complications.

CONCLUSIONS

Our findings suggest that FDIP is a useful and effective treatment for benign oral vascular lesions. FDIP treatment of these oral lesions is clinically significant because it provides effective management, avoids recurrence, and shortens healing time. We believe that the use of this method by medical and dental specialists should be supported.