case_images: PMC11057590_01
case_images: Extra-oral view showing left facial swelling
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case_images: On extra-oral clinical examination [Figure 1], gross facial asymmetry was detected with a diffuse palpable firm soft tissue swelling in the left middle and lower third of face.
case_images: Multiple venous channels with prominent arc-like calcifications were identified in USG
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case_images: The USG examination reported the lesion to be venous malformation with calcifications [Figure 2].
case_images: Panoramic radiograph showing phleboliths in left maxillary tuberosity and ramus region
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case_images: In panoramic radiograph, there was evidence of multiple calcifications overlapping the areas of left maxillary tuberosity and mandibular ramus region suggestive of phleboliths [Figure 3].
case_images: Axial section of CECT showing soft tissue swelling with hyperdense areas (a) and multiple calcifications adjacent to left ramus area (b)
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case_images: On contrast, multiple vessels are seen traversing through it with multiple chunky areas of calcifications [Figure 4].
case_images: Intra-operative pictures showing extracapsular dissection until the superior portion of masseter muscle (a) and after excision of stained part of soft tissue mass (b)
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case_images: The patient underwent surgery, direct cheek incision was made on the site of the lesion 10-12 mm behind the Zuker's point, and extracapsular dissection was done until the superior portion of masseter muscle [Figure 5] was identified. 2% Methylene blue dye was injected to identify the lesion.
case_images: Excision specimen and 14 phleboliths
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case_images: Total 14 phleboliths were identified and removed [Figure 6].
case_images: H and E staining shows connective tissue stroma with multiple dilated blood vessels (a); histopathology of phlebolith showing large eosinophilic area with inside basophilic area (b)
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case_images: The pathological examination confirmed the intra muscular cavernous hemangioma [Figure 7].
case_images: One-month postoperative picture showing satisfactory healing
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case_images: One-month postoperative follow-up showed satisfactory recovery, and presently patient is under periodic review [Figure 8].