An Interesting Case of an Unusual Radiologic Finding

An Unusual Radiologic Finding

Last year in June, I saw pleasant 18-year-old young lady or consultation regarding removal of her impacted and malposed wisdom teeth. At the consultation a thorough history was taken and her past medical history reviewed. Everything was negative except for a history of cavernous hemangioma involving lower lip and buccal mucosa. There was no obvious clinical involvement of the mandible or the area of the wisdom teeth.

 

 

The patient successfully underwent removal of her wisdom teeth and had an uneventful recovery. On routine examination at her dentist this year, he noticed some unusual calcifications in the area near the extraction site #17, and referred the patient for evaluation. Upon clinical exam of the patient I could palpate no obvious mass around the extraction site and the tissues in the area appeared within normal limits. Her hemangioma had not appeared to increase in size, but it did have a somewhat lumpy consistency in certain parts of the mass. The remainder of her oral examination was within normal limits.

Based upon my examination I referred the patient for a CBCT and obtained the following images:

What is your diagnosis of this interesting finding?

Answer: Phleboliths in the cavernous hemangioma of the left buccal mucosa.

Phleboliths are a rare finding in hemangiomas and are areas of dystrophic calcification within the mass of the hemangioma. Their cause is not clear, but thought to be due to altered blood flow hemodynamics, with areas of venous pooling which then go on to calcify. Because this particular hemangioma is not facially disfiguring for the patient, no further treatment is recommended. Treatment of facial hemangiomas is a challenging effort and most often involves a team approach including interventional radiology and surgery.

If you are experiencing any discomfort or pain with your wisdom teeth, we encourage you to contact the Texas Oral Surgery Group.  With offices in Plano, Denton, Decatur, and Gainesville, our elite oral surgeons have extensive experience providing wisdom teeth treatments to residents of the greater Plano region.  We look forward to assisting you!

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