Total Excision of an Intraosseous Zygomatic Hemangioma via Subciliary Approach

Abstract

intraosseus hemangiomas of the face and malar regions. 2. To review advantages and disadvantages of surgical approaches for removal of these lesions, including the Weber-Ferguson, hemi/bicoronal, extended transconjunctival, transoral gingivobuccal, and extended subciliary incisions. Study Design: Case report and review of the literature. Surgical, radiographic, and histopathologic findings are shown and discussed. Methods: We describe a case of a 44-year-old woman with a twoyear history of a slowly-enlarging, tender mass over her right zygoma. Magnetic resonance imaging demonstrated a lytic, expansile lesion centered within the cortex of the zygoma at the zygomaticomaxillary suture. Results: Total excision of the mass was achieved through a single extended subciliary incision. The lesion was dissected circumferentially out of the zygoma with a cuff of normal bone. Histopathologic examination revealed an intraosseus hemangioma. Conclusions: Intraosseus hemangioma is a rare lesion of the zygomatic area. En bloc surgical excision is the best treatment for these expansile masses. The cure rate is excellent if complete removal is achieved; however, as these are benign lesions, postoperative cosmetic deformities remain a significant issue when considering the surgical approach. Many reconstructive methods have been described to minimize bony defects following excision but do not address the extensive external skin incisions that are required and scarring that can result. A thorough understanding of the many skin incision options and selection of the least invasive approach that will permit complete resection are paramount. In select cases, an extended subciliary approach can provide the necessary exposure and a cosmetically favorable result. Total Excision of an Intraosseous Zygomatic Hemangioma via Subciliary Approach