Submandibular triangle cavernous hemangioma: Case report and review of literature

Hemangiomas in the submandibular triangle are relatively rare, and may be misdiagnosed as inflammatory lesions, benign tumors, IgG-related lesions, or salivary calculi. Diagnosis of these lesions is facilitated using appropriate imaging modalities. We report the case of a hemangioma occurring in the submandibular triangle region as well as a literature review of preoperative clinical diagnosis and image modalities. A 30-year-old woman was referred to our hospital from another dental clinic for treatment of a painful swelling of the left submandibular region. Contrast-enhanced magnetic resonance imaging (CE-MRI) showed a mass with clear boundaries in the left submandibular region. The CE-MRI dynamic study showed early enhancement and high washout. There was not abnormal accumulation of fluorodeoxyglucose (FDG) on positron emission tomography-CT (PET-CT), and it could not confirm a malignant lesion. Accordingly, the patient was suspected to have a submandibular gland benign tumor or arteriovenous malformation. The lesion is an arteriovenous malformation, but we judged it to be an extractable hemangioma. Intraoperatively, the lesion was found to be continuous with the submandibular gland and extracted en bloc. Surprisingly, histological diagnosis of the specimen was cavernous hemangioma. There was no recurrence at 4.5 years after surgery. The diagnosis of tumor-like disease occurring in the submandibular triangle region requires both collection of clinical findings and evaluation of the internal properties of the lesion. Preoperative diagnosis based on these combined findings enables construction of an appropriate treatment plan.