Long-term clinical and radiographic follow-up of presumptive intramuscular hemangioma of the masseter muscle: a case report

Abstract

We present a case of a 27-year-old Hispanic female with a presumptive intramuscular hemangioma (IMH) of the left masseter muscle. The tumor was first detected and imaged 15 years prior with computed tomography (CT), magnetic resonance (MR), and ultrasound (US) imaging studies. Serial MR studies reveal a lobulated mass involving the left masseter space with intermediate signal on T1 and bright signal on T2. CT images show anterior displacement of the facial vein and a calcification in the mass most consistent with a phlebolith or metaplastic ossification. The tumor exhibited mild growth during the patient’s youth but stabilized during adulthood. On clinical examination, the tumor is not readily apparent and the overlying oral mucosa and skin display no discoloration. However, a round 2.0 cm compressible mass of the buccal mucosa and overlying skin becomes visible when the patient masticates, clenches her jaw, is placed in Trendelenburg position, or vigorously exercises. These specific clinical features combined with the radiographic appearance of the tumor are most suggestive of an erectile IMH of the masseter muscle. Management of IMHs is individualized, but treatment is often wide local excision. In select cases, patients and clinicians may elect to monitor IMHs with routine clinical and radiographic examinations. This case highlights the clinical and radiographic appearance of an IMH of the masseter over a period of 15 years.