J Korean Assoc Oral Maxillofac Surg.  2017 Aug;43(4):262-266. 10.5125/jkaoms.2017.43.4.262.

Intramuscular hemangioma in buccal cheek: a case report

• Park JW
• Kim CH
• Moon CW

• KMID: 2391357
• DOI: http://doi.org/10.5125/jkaoms.2017.43.4.262

Abstract

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.

Keyword

Intramuscular hemangioma; Preoperative diagnosis; Surgical resection

MeSH Terms

Adolescent
Anesthesia, General
Blood Vessels
Cheek*
Diagnosis
Extremities
Head
Hemangioma*
Humans
Magnetic Resonance Imaging
Male
Mouth Mucosa
Muscle, Skeletal
Muscles
Neck

Figure

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  Fig. 1 Extraoral clinical photo.

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  Fig. 2 Intraoral clinical photo.

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  Fig. 3 Axial view on preoperative magnetic resonance imaging (T1-weighted). A circle shows isointense mass measuring 4×3 cm in size with well-contoured margin in the left abutting on the mandible, buccinator muscle, depressor orbicularis oris muscle, and subcutaneous fat layer.

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  Fig. 4 Axial view on preoperative magnetic resonance imaging (T2-weighted). A circle shows hyperintense mass with hypointense spaces suggesting phleboliths.

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  Fig. 5 Local bleeding control by ligation of feeding vessel.

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  Fig. 6 Extracted mass with several phleboliths.

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  Fig. 7 Cut surface of phlebolith (H&E staining, ×40). The phlebolith in the arrows appears concentric structure suggesting occurrence of sclerosis and the midportion looks more deep purple color because of minute calcification.

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  Fig. 8 Histopathologic examination of intramuscular hemangioma specimen (H&E staining, ×40). Asterisks indicate blood vessels sprouted into the muscles and multiple arrows point out the various patterns of muscle arrangement.

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