Head and Neck Intraosseous Hemangiomas: Anatomic Locations and Multidisciplinary Surgical Management

Introduction: Intraosseous hemangiomas (IH) are rare benign vascular malformations of bone accounting for less than 1% of all bony lesions. Facial bone IH, particularly around the orbit or zygoma are exceedingly rare, with the first case reported in 1950. In this series, we describe our experience with calvarial and facial IH, specifically surgical resection and reconstruction of orbital rim and zygomatic arch IH for tumors in this region that become symptomatic due to aesthetic concerns or physical mass effect on the globe, leading to diplopia, exophthalmos, or optic nerve compression.

Methods: This case series was a retrospective chart review of all patients who had IH resection in the facial or skull region at an academic, tertiary, referral hospital from 1992 to 2023. Patient demographics, pathology, management, and surgical and functional outcomes were analyzed.

Results: Of the 17 cases of IH in the facial and skull region there were 5 males and 12 females with a mean age at surgery of 54. Eleven (65%) were skull lesions, localizing to the frontal (41%) and parietal bones (23%). Five (29%) cases involved the orbital rim and zygomatic region, and 1 localized to the malar region. The orbital intraosseous hemangiomas (OIH) by ENT and ophthalmology in a multidisciplinary fashion.

The OIH cohort was largely female (80%) and White (80%, 20% race not reported) with a mean age at surgery of 61 years. Three of five OIH patients had full records available to analyze. The most common presenting symptoms were lesion growth (67%) and pain or discomfort (67%). All 3 patients underwent complete surgical resection en bloc using an osteotome or ultrasonic saw and lateral orbital rim or floor reconstruction with titanium mesh plates; one requiring local tissue temporalis fascia and superficial orbicularis oculi flap for volume.

Conclusions: Orbital rim involvement of IH is rarer than other facial and skull bone involvement. This location lends itself particularly well to resection and reconstruction in a multidisciplinary fashion with ENT and ophthalmology.