Intramuscular Hemangioma of the Head and Neck

Abstract

Intramuscular hemangiomas (IMH) are uncommon tumors in the head and neck region, occurring most often in the trunk and extremities. Preoperative misdiagnosis is common because of the deep location of these tumors. Ten recent cases of head and neck IMH are presented, five of which involve the masseter muscle--the most frequent site of involvement in the head and neck. Masseter IMH occurred almost exclusively in the pediatric age group. The clinical presentation, radiographic and histologic findings, treatment, complications, and outcome of these patients are presented. The vital role of preoperative diagnosis using magnetic resonance imaging (MRI) is discussed, as well as a review of the natural history of IMH and indications for surgical intervention.

Intramuscular cavernous hemangiomas arising from masseter muscles

“…60% is in these muscles. 5 Other sites in the head and neck are pterygoid, thyrohyoid, larynx, sternocleidomastoid, orbital and posterior neck muscles. 5,6 Intramuscular hemangiomas are commonly seen among adolescents and young adults, especially before the age of 30; however, they may affect older patients.…”

“…7,8 By physical examination, the most common initial presentation, there is a palpable, usually painless mass in the muscle. 5 A variety of tumors can be confused clinically with an IMH. These are salivary neoplasms, lymphangiomas, rhabdomyosarcomas, masseteric hypertrophy, and schwannoma.…”

“…Phlebolith is well seen via CT, but it unable to define tissue planes and the vascularity of the lesion. 5,6 MR imaging is a useful noninvasive technique for examinations of soft tissue and hemangioma because of its superior soft tissue contrast and multiplanar capability. MR imaging findings in hemangioma are frequently diagnostic.…”

“…MR imaging findings in hemangioma are frequently diagnostic. 5,9 Hemangioma generally appears as high signal intensity lobules that resemble a brunch of grapes on T2 weighted images. Hemorrhagic and calcified areas and fatty tissue that located in the hemangioma are responsible of heterogeneous signal intensity on T1 and T2 weighted sequences.…”

Posttraumatic Intramuscular Hemangioma Arising from Scalene Muscles in Supraclavicular Region

“…Although IMHs are generally located in the truncus and extremities, the most common site of origin is the masseter muscle in the head and neck region (2). They rarely originate in the trapezius, sternocleidomastoid, and temporal muscles.…”