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Cerqueira É, Correia S, Ramalhosa F, Lopes T, Mendes Abreu J. Challenges and Management of Capillary Intraosseous Hemangioma in the Mandibular Symphysis: A Case Report. Cureus 2024; 16:e58035. [PMID: 38738024 PMCID: PMC11088288 DOI: 10.7759/cureus.58035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Capillary intraosseous hemangioma is a benign vascular neoplasm that affects bone tissue, yet its occurrence in the jaw bones has been seldom reported in the literature. We present a case of a capillary intraosseous hemangioma located in the mandibular symphysis of a 28-year-old male. Initially addressed by the patient's dentist as an infectious lesion of endodontic origin, the sudden worsening of the condition, marked by the development of a rapidly expanding exophytic mandibular lesion and tooth mobility, led to the consideration of various potential diagnoses. Subsequently, an incisional biopsy was performed, triggering multiple episodes of recurrent bleeding, leading to several visits to the emergency department, and prompting an urgent status upgrade for the patient. Upon the histological diagnosis of vascular neoplasm, the patient underwent the excision of the lesion, with a favorable and uneventful evolution, although with expected sequelae. As a result, a temporary prosthetic solution, comprising a Maryland Bridge, was implemented, with plans for guided bone regeneration and implant-supported fixed dental prostheses currently in progress. This case underscores the diagnostic and therapeutic challenges associated with this rare condition. Consequently, achieving the optimal outcome for the patient largely depends on a multidisciplinary approach, emphasizing the critical importance of thorough preoperative assessment, along with a well-devised treatment plan and rapid intervention.
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Affiliation(s)
| | | | - Fátima Ramalhosa
- Pathology, Clinical and Academic Centre of Coimbra, Coimbra, PRT
| | - Teresa Lopes
- Maxillofacial Surgery, ULS Coimbra, Coimbra, PRT
| | - João Mendes Abreu
- Faculty of Medicine, Clinical and Academic Centre of Coimbra, Coimbra, PRT
- Stomatology, Clinical and Academic Centre of Coimbra, Coimbra, PRT
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Antúnez-Conde R, Navarro Cuéllar C, Salmerón Escobar JI, Díez-Montiel A, Navarro Cuéllar I, Dell’Aversana Orabona G, del Castillo Pardo de Vera JL, Navarro Vila C, Cebrián Carretero JL. Intraosseous Venous Malformation of the Zygomatic Bone: Comparison between Virtual Surgical Planning and Standard Surgery with Review of the Literature. J Clin Med 2021; 10:jcm10194565. [PMID: 34640581 PMCID: PMC8509390 DOI: 10.3390/jcm10194565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 01/02/2023] Open
Abstract
Intraosseous venous malformations affecting the zygomatic bone are infrequent. Primary reconstruction is usually accomplished with calvarial grafts, although the use of virtual surgical planning, cutting guides and patient-specific implants (PSI) have had a major development in recent years. A retrospective study was designed and implemented in patients diagnosed with intraosseous venous malformation during 2006–2021, and a review of the scientific literature was also performed to clarify diagnostic terms. Eight patients were treated, differentiating two groups according to the technique: four patients were treated through standard surgery with resection and primary reconstruction of the defect with calvarial graft, and four patients underwent resection and primary reconstruction through virtual surgical planning (VSP), cutting guides, STL models developed with CAD-CAM technology and PSI (titanium or Polyether-ether-ketone). In the group treated with standard surgery, 75% of the patients developed sequelae or morbidity associated with this technique. The operation time ranged from 175 min to 210 min (average 188.7 min), the length of hospital ranged from 4 days to 6 days (average 4.75 days) and the postoperative CT scan showed a defect surface coverage of 79.75%. The aesthetic results were “excellent” in 25% of the patients, “good” in 50% and “poor” in 25%. In the VSP group, 25% presented sequelae associated with surgical treatment. The operation time ranged from 99 min to 143 min (average 121 min), the length of hospital stay ranged from 1 to 2 days (average of 1.75 days) and 75% of the patients reported “excellent” results. Postoperative CT scan showed 100% coverage of the defect surface in the VSP group. The multi-stage implementation of virtual surgical planning with cutting guides, STL models and patient-specific implants increases the reconstructive accuracy in the treatment of patients diagnosed with intraosseous venous malformation of the zygomatic bone, reducing sequelae, operation time and average hospital stay, providing a better cover of the defect, and improving the precision of the reconstruction and the aesthetic results compared to standard technique.
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Affiliation(s)
- Raúl Antúnez-Conde
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | - Carlos Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
- Correspondence:
| | - José Ignacio Salmerón Escobar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | - Alberto Díez-Montiel
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | - Ignacio Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | | | | | - Carlos Navarro Vila
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (R.A.-C.); (J.I.S.E.); (A.D.-M.); (I.N.C.); (C.N.V.)
| | - José Luis Cebrián Carretero
- Maxilofacial Surgery Department, Hospital Universitario La Paz, 28046 Madrid, Spain; (J.L.d.C.P.d.V.); (J.L.C.C.)
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Temerek AT, Ali S, Shehab MF. Computer guided resection and reconstruction of intra-osseous zygomatic hemangioma: Case report and systematic review of literature. Int J Surg Case Rep 2019; 66:240-256. [PMID: 31874384 PMCID: PMC6931065 DOI: 10.1016/j.ijscr.2019.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/30/2019] [Accepted: 12/10/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES to systemically integrate the available data on various published treatment strategies for intraosseous hemangioma of the zygoma in an updated comprehensive systematic review, and to present a new case of treated resection and immediate reconstruction using computer guided patient specific composite graft. CASE PRESENTATION A 29 years old female patient with intraosseos zygomatic hemangioma treated using computer guided resection and immediate reconstruction. The resection was performed using a resection template constructed based on preoperative 3D planning. The reconstruction was performed using ramus bone graft and titanium mesh. The patient was followed up for 3 years with no complications. METHODS An electronic search was performed on 3 data bases; additional hand search of bibliographies of selected articles was performed. Eligibility criteria include human studies presenting intraosseous zygomatico-orbital hemangioma with clearly reported therapeutic strategies. RESULTS 53 articles with 73 cases were included. The lesion was highly prevalent in females compared to males (2.28:1). Fifth decade represents the highest prevalence with mean age of 44.1 ± 1.8 years. The main patient concern was swelling and facial deformity. Total tumor resection can assure no recurrence, while partial resection and curettage are associated with high recurrence rate.
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Affiliation(s)
- Ahmed Talaat Temerek
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, South Valley University, Qena, Egypt.
| | - Sherif Ali
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, Cairo, Egypt.
| | - Mohamed Farid Shehab
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, Cairo, Egypt.
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An Algorithm for Managing Intraosseous Vascular Anomalies of the Craniofacial Skeleton. J Craniofac Surg 2018; 29:622-627. [PMID: 29068964 DOI: 10.1097/scs.0000000000004014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Intraosseous vascular anomalies (IOVA) are rare in the craniofacial skeleton and present a diagnostic and therapeutic challenge. This study aims to describe the clinical management based on a large case series. METHODS A retrospective chart review was performed and 9 IOVA were identified over a 15-year period. Data on demographics, diagnostic features, clinical management, and outcomes were reviewed. RESULTS Five frontal bone IOVA and 4 orbital IOVA were identified. The postoperative follow-up ranged from 4 months to 4 years. All 9 lesions were diagnosed with computed tomography (CT) imaging. Magnetic resonance imaging (MRI) was used to delineate soft tissue involvement in 2 patients presenting with oculo-orbital dystopia and ophthalmoplegia. En bloc excision was performed in all patients. Preoperative interventional embolization was critical in the successful resection of an orbital IOVA following 2 previously failed attempts that were aborted secondary to hemorrhage. Intraoperative 3-dimensional stereotactic navigation was used for the accurate en bloc excision of a frontal IOVA to prevent injury to the frontal sinus. Reconstruction of esthetic and functional deformities was successfully accomplished. CONCLUSION The diagnosis of IOVA relies primarily on clinical assessment and CT imaging. Further interpretation of the involvement of periorbital, facial, and intracranial soft tissue is best defined by MRI. Multidisciplinary care with interventional radiology and neurosurgery must be considered for ensuring the safe and adequate en bloc excision of craniofacial IOVA.
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Powers DB, Fisher E, Erdmann D. Zygomatic Intraosseous Hemangioma: Case Report and Literature Review. Craniomaxillofac Trauma Reconstr 2016; 10:1-10. [PMID: 28210401 DOI: 10.1055/s-0036-1592087] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 04/10/2016] [Indexed: 10/20/2022] Open
Abstract
Intraosseous hemangiomas are uncommon intrabony lesions, representing approximately 0.5 to 1% of all intraosseous tumors. Their description varies from "benign vasoformative neoplasms" to true hamartomatous proliferations of endothelial cells forming a vascular network with intermixed fibrous connective tissue stroma. These commonly present as a firm, painless swelling. Intraosseous hemangiomas present more commonly in females than in males and most likely occur in the fourth decade of life. The most common etiology of intraosseous hemangioma is believed to be prior trauma to the area. They have a tendency to bleed briskly upon removal or biopsy, making preoperative detection of the vascular nature of the lesion of significant importance. There are four variants: (1) capillary type, (2) cavernous type, (3) mixed variant, and (4) scirrhous type. Generally most common in the vertebral skeleton, they can also present in the calvarium and facial bones. In the head, the most common site is the parietal bone, followed by the mandible, and then malar and zygomatic regions. Intraosseous hemangiomas of the zygoma are rare entities with the first case reported in 1950 by Schoenfield. In this article, we review 49 case reports of intraosseous hemangioma of the zygoma, and also present a new case treated with excision followed by polyether-ether ketone implant placement for primary reconstruction.
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Affiliation(s)
- David B Powers
- Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Elda Fisher
- Department of Oral and Maxillofacial Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Detlev Erdmann
- Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Myadam S, Kishan V, Deepa A, Shri Puja K, Divya Rani K. Intraosseous hemangioma of the zygomatic bone: A rare site for hemangioma. Med J Armed Forces India 2016; 72:85-7. [PMID: 26900231 DOI: 10.1016/j.mjafi.2014.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 10/24/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Shravani Myadam
- Senior Resident (Radiology), Kamineni Institute of Medical Sciences, Narketpally, Andhra Pradesh, India
| | - Venkat Kishan
- Consultant (Radiology), Kamineni Institute of Medical Sciences, Narketpally, Andhra Pradesh, India
| | - A Deepa
- Senior Resident (Radiology), Kamineni Institute of Medical Sciences, Narketpally, Andhra Pradesh, India
| | - K Shri Puja
- Junior Resident (Radiology), Kamineni Institute of Medical Sciences, Narketpally, Andhra Pradesh, India
| | - K Divya Rani
- Junior Resident (Radiology), Kamineni Institute of Medical Sciences, Narketpally, Andhra Pradesh, India
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8
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Gologorsky Y, Shrivastava RK, Panov F, Mascitelli J, Signore AD, Govindaraj S, Smethurst M, Bronster DJ. Primary intraosseous cavernous hemangioma of the clivus: case report and review of the literature. J Neurol Surg Rep 2013; 74:17-22. [PMID: 23943715 PMCID: PMC3713557 DOI: 10.1055/s-0033-1346980] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 02/19/2013] [Indexed: 11/03/2022] Open
Abstract
Primary intraosseous hemangiomas are benign, vascular malformations that account for approximately 1% of all primary bone neoplasms. These tumors are mostly found in vertebral bodies and are rarely seen in the calvarium, where they represent 0.2% of bony neoplasms. When found in the skull, they tend to present with vague symptoms and do not have the typical radiological findings suggestive of hemangiomas. Because of this, these tumors can be missed in many cases or may be misinterpreted as more ominous lesions like multiple myeloma or osteosarcoma. Involvement of the skull base is exceedingly rare, and presentation with cranial nerve unilateral polyneuropathies has not been reported. We report a patient case with review of recent pertinent literature.
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Affiliation(s)
- Yakov Gologorsky
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York, USA
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9
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Mishra MB, Bishen KA, Yadav A. Capillary hemangioma: An occasional growth of attached gingiva. J Indian Soc Periodontol 2013; 16:592-6. [PMID: 23493929 PMCID: PMC3590733 DOI: 10.4103/0972-124x.106924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 06/18/2012] [Indexed: 11/13/2022] Open
Abstract
The capillary hemangiomas represent developmental hamartomatous lesions of vascular tissue and their growth stops after certain period of time, following which some of the hemangiomas may involute. Capillary hemangiomas are common tumors of infancy and adolescents. Although head and neck are the most prevalent sites for origin of hemangiomas, they are very rarely observed arising on attached gingiva. This paper presents a rare case report of capillary hemangioma on attached gingiva of posterior maxilla in an adult female. Surgical management was done by Widman's periodontal flap operation with satisfactory uneventful healing. The characteristic clinical and histo-pathologic features of vascular tumors and malformations, especially capillary hemangiomas are discussed.
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Affiliation(s)
- Mahavir B Mishra
- Department of Periodontics, Mahatma Gandhi Dental College, Jaipur, Rajasthan, India
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10
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Gonçalves FG, Rojas JPO, Hanagandi PB, Valente R, Torres CI, Chankwosky J, Delcardio-O'Donovan R. Case report: Periorbital intraosseous hemangiomas. Indian J Radiol Imaging 2012; 21:287-90. [PMID: 22223942 PMCID: PMC3249945 DOI: 10.4103/0971-3026.90691] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Hemangiomas are hamartomatous proliferation of vessels. Intraosseous hemangiomas of the facial bones are rare and most commonly involve the zygoma, maxilla, mandible, and the nasal bones. A “sunburst” pattern is a typical appearance on CT scan and MRI and therefore a biopsy is not always necessary. Surgery is usually performed in symptomatic cases. The authors describe five typical periorbital intraosseous hemangiomas with a brief review of literature.
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Kondylidou-Sidira A, Dietrich EM, Koloutsos G, Sakkas L, Antoniades K. Intraosseous vascular malformation of the mandibular condyle: presentation of a case and differential diagnosis. Oral Radiol 2012. [DOI: 10.1007/s11282-012-0090-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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13
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Rao PK, Bejai V, Rao S, Shetty SR. Co-occurrence of intraoral hemangioma and port wine stain: A rare case. Indian Dermatol Online J 2012; 3:28-30. [PMID: 23130257 PMCID: PMC3481928 DOI: 10.4103/2229-5178.93493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hemangiomas are neoplastic proliferations of endothelial cells, characterized by a period of growth after birth, and eventual spontaneous involution. The course can be uneventful with spontaneous resolution; or it may be marked by complications such as infection, bleeding, ulceration, visual defects and feeding difficulties. Apart from these, rare life-threatening complications such as congestive heart failure and consumption coagulopathy may also be seen. Although hemangiomas commonly occur in the head and neck region, intraoral occurrence is relatively rare. A port wine stain is defined as a macular telangiectatic patch which is present at birth and remains throughout life. They may be localized or extensive, affecting a whole limb. This article reports a rare case of co-occurrence of port wine stain with intraoral hemangioma.
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Affiliation(s)
- Prasanna Kumar Rao
- Department of Oral Medicine and Radiology, Yenepoya Dental College, Mangalore, Karnataka, India
| | - Vishal Bejai
- Department of Dermatology, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India
| | - Sanath Rao
- Department of Dermatology, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India
| | - Shishir Ram Shetty
- Department of Oral Medicine and Radiology, AB Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore, Karnataka, India
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Jois HS, Kumar K P M, Kumar MS, Waghrey S. A mixed neoplasm of intraosseous hemangioma with an ameloblastoma: a case of collision tumor or a rare variant? Clin Pract 2012; 2:e5. [PMID: 24765404 PMCID: PMC3981335 DOI: 10.4081/cp.2012.e5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 11/23/2011] [Accepted: 12/05/2011] [Indexed: 11/23/2022] Open
Abstract
Hemangiomas of the head and neck are considered to be benign tumors of infancy that are characterized by a rapid growth phase with endothelial cell proliferation, followed by gradual involution. Central hemangiomas are a rare occurrence and even rarer are the hybrid tumors of central hemangiomas with odontogenic tumors such as ameloblastomas. This paper reports a case of one such hybrid tumor in a middle aged adult clinical presenting as a mandibular swelling with indistinct mixed radiographic presentation and histopathologically comprising of intimately associated hemangiomatous vascular channels and typical ameloblastic areas. To the authors' knowledge this is the sixth case of such a hemangiomatous ameloblastoma which has been reported till date.
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Aldridge E, Cunningham LL, Gal TJ, Yepes JF, Abadi BJ. Intraosseous venous malformation of the mandible: a review on interdisciplinary differences in diagnostic nomenclature for vascular anomalies in bone and report of a case. J Oral Maxillofac Surg 2011; 70:331-9. [PMID: 21798650 DOI: 10.1016/j.joms.2011.03.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 03/12/2011] [Accepted: 03/15/2011] [Indexed: 12/01/2022]
Affiliation(s)
- Eron Aldridge
- Division of Oral and Maxillofacial Surgery, University of Kentucky Chandler Medical Center, Lexington, KY 40536, USA
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16
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Massive craniofacial intraosseous vascular malformation resembling cystic angiomatosis: report of 2 cases and review of the literature. J Oral Maxillofac Surg 2010; 69:204-14. [PMID: 21050648 DOI: 10.1016/j.joms.2010.07.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 07/18/2010] [Accepted: 07/29/2010] [Indexed: 11/23/2022]
Abstract
Cystic angiomatosis of bone is a rare condition of multifocal angiomas of the skeleton. The condition is believed to be congenital, grows slowly and starts in first decades of life. Two cases of progressive bimaxillary enlargement, presented here with a history of slowly enlargement of facial bones when they were 9 and 6 year old, respectively. Radiographic evaluation of the craniofacial bones revealed aggressive hypertrophy with severe displacement of the teeth. The histopathological evaluation of the gross specimen showed vital bone containing capillary and cavernous spaces with endothelial lining. Aggressive cystic angiomatosis of the facial bones was described here as the most probable diagnosis.
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Srinivasan B, Ethunandan M, Van der Horst C, Markus AF. Intraosseous 'haemangioma' of the zygoma: more appropriately termed a venous malformation. Int J Oral Maxillofac Surg 2009; 38:1066-70. [PMID: 19574025 DOI: 10.1016/j.ijom.2009.05.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 11/29/2008] [Accepted: 05/28/2009] [Indexed: 11/28/2022]
Abstract
Vascular anomalies often affect the soft tissues and primary intraosseous lesions are uncommon, with only 33 cases reported in the zygoma. Intraosseous vascular anomalies of the zygoma have traditionally been designated 'haemangiomas' with little attempt to clarify the specific type of the lesion. Recently, specific immunohistochemical markers such as erythrocyte type glucose transporter protein 1 (GLUT-1) have been described to differentiate haemangiomas and vascular malformations. The authors report a case of intraosseous venous malformation of the zygoma and provide supporting evidence to justify the nomenclature. The literature on zygomatic 'haemangiomas' is critically reviewed and the basis for their proper designation as venous malformations highlighted.
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Affiliation(s)
- B Srinivasan
- Department of Oral and Maxillofacial Surgery, Poole, Dorset, UK
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Abstract
Intraosseous hemangiomas are classified as benign tumors of vascular nature. Some authors describe them as hamartomas. They originate and expand inside bone structures. They are usually congenital, rarely of posttraumatic origin. In the Maxillo-Facial Surgery departments of the Universities of Rome "La Sapienza" and "Tor Vergata," from 1990 to 2004, 11 cases of intraosseous hemangioma have been diagnosed. In 6 cases, the neoplasm localized in the zygomatic region; in 3 cases, at the mandible level; in 1 patient, in the maxillary site; and in 1 patient, in the frontal bone. Literature review and the case of a male patient affected by left orbitozygomatic hemangioma are described.
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Gómez E, González T, Arias J, Lasaletta L. Three-dimensional reconstruction after removal of zygomatic intraosseous hemangioma. Oral Maxillofac Surg 2008; 12:159-162. [PMID: 18636281 DOI: 10.1007/s10006-008-0115-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Intraosseous hemangioma, especially in the zygomatic area, is a very rare pathologic condition among the osseous tumors of the head and neck area. Clinical presentation includes a painless mass with progressive growth and hard consistence. Diagnosis is performed by means of computed tomography (CT). Treatment includes radical en bloc surgical excision with healthy bone margins in order to avoid blood loss. Previous embolization is not necessary. Bony defect reconstruction must be performed to avoid secondary deformities. CASE REPORT We present a case report of a 30-year-old female presenting a progressive painless swelling in the malar and zygomatic regions. CT scan demonstrated a right zygomatic lesion that extended into the orbital floor and lateral orbital wall, affecting also the zygomatic arch. The biopsy revealed an intraosseous hemangioma. Treatment was performed including an en bloc resection with healthy bony margins and primary reconstruction with calvarian bone graft in association with galea-pericranium flap.
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Affiliation(s)
- Elena Gómez
- Oral and Maxillofacial Surgery Service, Hospital Universitario La Paz, Madrid, Spain.
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Torres-Carranza E, García-Perla A, Infante-Cossío P, Acosta-Feria M, Belmonte-Caro R, Gutiérrez-Pérez J. Hemangioma intraóseo primario de la órbita: a propósito de dos casos. Neurocirugia (Astur) 2007. [DOI: 10.1016/s1130-1473(07)70276-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zins JE, Türegün MC, Hosn W, Bauer TW. Reconstruction of intraosseous hemangiomas of the midface using split calvarial bone grafts. Plast Reconstr Surg 2006; 117:948-53; discussion 954. [PMID: 16525289 DOI: 10.1097/01.prs.0000204768.82643.0c] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intraosseous hemangiomas are benign lesions that usually occur in the vertebral column and the calvaria. They are rare in the midface, with only 22 zygomatic and 26 nasal bone hemangioma cases described in the literature. Methods of reconstruction of craniofacial defects after surgical removal of these tumors have been inconsistent. METHODS The authors report long-term follow-up in three cases of midface intraosseous hemangiomas all treated in a similar fashion: surgical excision of the tumor with a small margin of normal bone and primary reconstruction using split calvarial bone grafts. RESULTS Clinical, photographic, and computed tomographic assessment (cases 1 and 2) documents no recurrence and maintenance of the result with a mean 5-year follow-up. To the authors' knowledge, this represents the longest follow-up of a patient series with hemangiomas of bone treated with primary reconstruction in the plastic surgery literature (Wolfe and Berkowitz did report on a single case with 4-year follow-up without recurrence). We recommend replacing like with like. Primary bone grafting with autogenous cranial bone was used to replace areas where original bone was thin, but full-thickness bone was used in areas where original bone was thick. Full-thickness cranial bone grafts may be superior to split cranial bone with regard to long-term volume maintenance. CONCLUSIONS Preoperative computed tomographic scanning should lead to the appropriate diagnosis. Proper diagnosis should lead to appropriate treatment, which includes total excision and primary bone grafting of the defect to prevent soft-tissue contraction.
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Affiliation(s)
- James E Zins
- Department of Plastic Surgery and Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Perugini M, Renzi G, Gasparini G, Cerulli G, Becelli R. Intraosseous Hemangioma of the Maxillofacial District: Clinical Analysis and Surgical Treatment in 10 Consecutive Patients. J Craniofac Surg 2004; 15:980-5. [PMID: 15547387 DOI: 10.1097/00001665-200411000-00018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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.
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Affiliation(s)
- Maurizio Perugini
- Department of Maxillofacial Surgery, University of Rome, Umberto I Hospital, Rome, Italy.
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23
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Taylan G, Yildirim S, Gideroğlu K, Aköz T. CONSERVATIVE APPROACH IN A RARE CASE OF INTRAZYGOMATIC HEMANGIOMA. Plast Reconstr Surg 2003; 112:1490-2. [PMID: 14504546 DOI: 10.1097/01.prs.0000080511.23265.24] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Zygomatic hemangioma is an extremely rare, benign, slow-growing tumor occurring mostly in adult women. The radiologic findings are diagnostic. Total excision of the tumor with primary reconstruction of the defect is the preferred treatment modality. We present a case of zygomatic hemangioma and a brief review of the literature.
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Affiliation(s)
- Serap Koybasi
- Department of Otolaryngology Head & Neck Surgery, Abant Izzet Baysak University, Bolu, Turkey
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25
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Honda M, Toda K, Baba H, Yonekura M. Congenital cavernous angioma of the temporal bone: case report. SURGICAL NEUROLOGY 2003; 59:120-3; discussion 123. [PMID: 12648911 DOI: 10.1016/s0090-3019(02)00985-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Congenital cavernous angioma is a very rare tumor that occurs in young adolescents. We describe a rare case of congenital cavernous angioma of the temporal bone in a neonate. Ultrasonography (US) and dynamic magnetic resonance imaging (MRI) were helpful in its diagnosis. CASE DESCRIPTION US and MRI of the fetus in the 32nd week of gestation revealed a large extra-axial tumor with intra- and extracranial extension. After the birth, US and dynamic MRI studies were performed in addition to conventional CT and MRI. These findings were compatible with cavernous angioma. The mass was totally removed on the fourth day of life and was found at surgery to originate from the skull. Histopathological diagnosis was cavernous angioma. The usefulness of US and dynamic MRI are also discussed. CONCLUSION US and dynamic MRI are useful, less invasive techniques for diagnosing this rare type of tumor. They provide useful information to differentiate calvarial mass lesions in neonates.
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Affiliation(s)
- Masaru Honda
- Department of Neurosurgery, National Nagasaki Medical Center, Omura, Japan
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26
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Liu JK, Burger PC, Harnsberger HR, Couldwell WT. Primary Intraosseous Skull Base Cavernous Hemangioma: Case Report. Skull Base 2003; 13:219-228. [PMID: 15912181 PMCID: PMC1131855 DOI: 10.1055/s-2004-817698] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Primary intraosseous cavernous hemangiomas (PICHs) of the skull base are extremely rare tumors. These lesions are most common in the frontal and parietal bones of the calvarium. The authors describe a 40-year-old female who presented with progressive headaches. Serial imaging revealed a contrast-enhancing intraosseous lesion of the lateral body of the sphenoid bone and the greater wing associated with encroachment of the inferior cavernous sinus and mild posterior displacement of the cavernous carotid artery. Follow-up imaging 9 years later revealed slow growth of the lesion. The patient underwent complete excision of the PICH through an extradural frontopolar approach. Pathological examination revealed an intraosseous cavernous hemangioma. PICHs of the skull base can mimic other more common skull base lesions and thus can be difficult to diagnose preoperatively. Diagnosis is usually made at surgery. The authors review the literature regarding the clinical presentation, radiological characteristics, pathological features, and surgical management of PICHs.
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Affiliation(s)
- James K. Liu
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Peter C. Burger
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - H. Ric Harnsberger
- Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - William T. Couldwell
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah
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Abstract
We report a case of first rib hemangioma that caused thoracic outlet syndrome. A 50-year-ole woman who was admitted to our hospital with a clinical diagnosis of thoracic outlet syndrome presented with fullness and easy fatigue of her right arm. Her right arm discomfort was associated with intermittent engorgement of superficial veins over the shoulder girdle. A chest radiograph revealed an enlargement of the anterior aspect of the first rib with fine bony trabeculations. Computed tomography scan showed contrast enhancement over the enlarged rib. Our tentative preoperative diagnosis was a benign first rib hypertrophic change, such as an old fracture with exuberant callus formation. A right-arm venogram revealed a patent subclavian vein with an extrinsic compression, which occluded on arm abduction. The findings of neural conduction studies of both upper extremities were symmetric and normal. The patient agreed to surgery because of the occlusive condition of the subclavian vein on arm abduction and progressive arm weakness in recent months. Segmental transection of the offending portion of the enlarged first rib was complicated by difficulty in isolating the whole length of the compressed but normal-appearing subclavian vein by our initial transaxillary and infraclavicular approaches because the medial aspect of the subclavian vein was obstructed by the enlarged first rib, which extended medially to the junction of the right jugular and subclavian veins. Successful segmental transection of the enlarged first rib was finally accomplished by combined transaxillary, infraclavicular, and supraclavicular approaches. A moderate amount of rib bleeding from resection ends was noted during segmental resection of the enlarged first rib, resulting in local hematoma formation. A 470-mL bloody discharge was collected from the vacuum ball inserted via the transaxillary route during her 12-day hospitalization. Pathologic examination revealed an intraosseous hemangioma. The patient had a prolonged course to partial recovery of her arm numbness, but signs of venous compression were much improved at 6 months' follow-up. Although hemangioma is benign, its hypervascular nature may cause catastrophic intraoperative bleeding.
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Affiliation(s)
- K M Yeow
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Tao Yuan, Taiwan.
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29
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Nakahira M, Kishimoto S, Miura T, Saito H. Intraosseous hemangioma of the vomer: a case report. AMERICAN JOURNAL OF RHINOLOGY 1997; 11:473-7. [PMID: 9438061 DOI: 10.2500/105065897780914956] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We describe an unusual case of intraosseous hemangioma of the vomer. The lesion had a characteristic radiographic appearance, especially on the computed tomographic scan. The two most interesting points in this case were the rarity as a site for the occurrence of hemangioma and the successful extirpation of the tumor via the Le Fort 1 osteotomy approach without embolization of the feeding vessels. The benefits of this approach included the wide surgical field afforded deep in the midface region, which was important for controlling bleeding, as well as the complete extirpation of the tumor.
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Affiliation(s)
- M Nakahira
- Department of Otolaryngology, Kochi Medical School, Japan
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30
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Affiliation(s)
- G Savastano
- Department of Maxillo-facial Surgery, Federico II University of Naples, Italy
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Hirano S, Shoji K, Kojima H, Omori K. Use of hydroxyapatite for reconstruction after surgical removal of intraosseous hemangioma in the zygomatic bone. Plast Reconstr Surg 1997; 100:86-90. [PMID: 9207663 DOI: 10.1097/00006534-199707000-00015] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Two rare cases of intraosseous hemangiomas in the zygomatic bone that were repaired after surgical removal of the tumor with hydroxyapatite implants are reported. Case 1 is a 42-year-old woman, and case 2 is a 46-year-old man. They complained of swelling in the right cheek. An intraosseous tumor in the right zygomatic bone was observed in both patients. The tumor was resected, and hydroxyapatite was employed to repair the defect caused by removal. After 4 years since the operation in case 1 and 8 months in case 2, the patients show satisfactory cosmetic appearance. Hydroxyapatite implant was useful for reconstruction of the defect after surgical removal of hemangiomas in the zygomatic bone.
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Affiliation(s)
- S Hirano
- Department of Otolaryngology, Kyoto University Hospital, Japan
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