A 28-year-old male patient with no history of interest consulted for a non-painful, progressive left malar tumor that had been noticed for 15 days.
She had no history of local trauma.
The exploration revealed a hard consistency lesion in the infero-external rim of the left orbit, approximately 1 cm in diameter, with no apparent pulsatility.
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Doppler ultrasonography revealed an expansive, polylobulated malar lesion with partial calcification and no vascular sign.
Orbital computed tomography (CT) detected a rounded, well-defined, medullary lesion with trabeculate internal structure and cortical expansion without peritic reaction.
Magnetic resonance imaging (MRI) described an expansive malar osteolytic lesion of 16x10x13mm, with well-defined sclerotic margins, absence of soft tissues surrounding the lesion and intense uptake of contrast agents.
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Diagnosis of presumptive low flow vascular lesion and given the progressive characteristics of the lesion, it was decided to remove the lesion under general anesthesia.
The lesion was exposed through a left subclavian dissection towards the malar tail and plane dissection.
After an osteotomy in box, including a peripheral safety margin of 0.5cm, the defect was repaired with a menses and arched titanium plate graft.
Intercortical gaps were filled with spongy bone obtained from the donor site.
Postoperative controls show an anatomical reconstruction with good bone healing.
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The anatomopathological study revealed dilated vascular spaces lined with endothelium without atypia, concluding an intraosseous cavernous angioma.
However, the immunohistochemical study was negative for GLUT-1.
Therefore, we consider that the correct clinical and immunohistochemical diagnosis is intraosseous venous malformations.
After 5 months of follow-up, the patient is completely asymptomatic, with excellent aesthetic results.
