Calcified Structures in Cheek : A Case Report

Vascular malformations (VMs) are defined as lesions present at birth that may not appear clinically until second or third decade of life with no gender predispositions. However, these malformations generally develops as the child grows and remains stable for years. These lesions become prominent because of an event such as trauma, surgery, infection, or hormonal disturbances. They are categorized into low-flow and high-flow lesions according to characteristics of blood flow. Clinically, VMs are classified as capillary, cavernous and mixed types. The most common one is arterio-venous malformation (AVM). Intramuscular hemangiomas (IMHs) represent about 15% of VMs and phleboliths are usually found in about 25% of IMHs. Phleboliths are calcified thrombi which are formed from stasis of blood flow secondary to injured blood vessel. In this case report, we presented a 44 years old female with swelling at the left buccal mucosa for almost twenty years. She complained of episodic throbbing pain and denied any change in size of the swelling. The bluish coloured swelling was measuring about 2cm x 2cm extending from left maxillary edentulous ridge to left buccal mucosa with engorged vessel opposite to tooth 25. Computerized Tomography (CT) was taken and showed small, multiple, radiopaque pebble like structures at left masseteric muscle. Patient then underwent surgical excision of lesion at left buccal mucosa under general anesthesia without any complications. Specimen sent for histopathological examination revealed it was phlebolith. In conclusion, intramuscular hemangioma with phleboliths should be considered in the differential diagnosis of calcified lesions of the maxillofacial regions, such as sialoliths, calcified lymph nodes, tonsilloliths, antroliths and carotid artery calcifications.