Submandibular venous malformation phleboliths mimicking sialolithiasis in children

Venous malformation phleboliths mimicking submandibular sialadenitis in children

To report one paediatric patient who presented with a rare venous vascular malformation as a mass in the left submandibular region with a clinical picture compatible with sialadenitis. Phleboliths are a specific feature of venous malformations due to venous stasis and may mimic sialoliths on various imaging modalities. Thus venous malformations are often misdiagnosed as sialadenitis due to sialolithiasis. Sialoliths are extremely rare in paediatric patients. In an early adolescent presenting with a submandibular mass and suspected sialadenitis arising from sialoliths, a detailed history, clinical examination and careful review of the radiological findings will allow the diagnosis of venous vascular malformation and provide the complete surgical resection. Our patient was initially referred with a presumed diagnosis of submandibular sialadenitis, and instead a venous malformation with phlebolith was diagnosed.

[Flebolites in the maxillofacial region: a challenge for imaging diagnosis. A review]

Vascular alterations or disorders of the blood and / or lymphatic vessels have their own characteristics, the identification of calcifications being a correct parameter to be able to make a proper diagnosis. The objective of the study was to describe the radiographic characteristics of the phleboliths, and whether they represent a challenge for diagnosis. according to the literature reviewed in the Medline (PubMed) database, Scielo, Google Scholar and some specialized journals. Phleboliths were found to have very particular radiographic characteristics, with concentric radiolucent and radiopaque images that resemble rings. However, not all the presentations are similar, this makes the diagnosis misleading with other calcifications in this region, such as sialoliths where their appearance is usually similar. Furthermore, there is the relationship with vascular anomalies and hemangiomas. finally, the evidence points to very specific characteristics of this lesion, and it is necessary to individualize each case, due to the differences that exist from one patient to another.

Practical Salivary Ultrasound Imaging Tips and Pearls

Ultrasound imaging is a valuable and effective clinical tool for salivary gland disorder evaluation and management. Pathologies including salivary duct stenosis, sialolithiasis, neoplasms, and autoimmune disorders have characteristic sonographic features. Maneuvers such as bimanual palpation and oral administration of sialagogues during the ultrasound examination can enhance examination findings. Ultrasound guidance is useful for targeting needle biopsies of neoplasms, ensuring appropriate intraparenchymal gland injections, and augmenting salivary duct instrumentation and intraoperative management.

Arteriovenous vascular malformation of the submandibular gland masquerading as Küttner's tumour

Chronic sclerosing sialadenitis, also known as Küttner's tumour, is a chronic inflammatory condition affecting the salivary glands. We present the case of an arteriovenous vascular malformation (AVM) of the right submandibular gland mimicking a Küttner's tumour on ultrasound scan in a 63-year-old woman. Examination revealed a 2 cm firm, mobile, non-pulsatile, right-sided submandibular mass with no overlying skin changes but with mild tenderness to palpation. Histological appearances revealed an AVM associated with localised fatty metaplasia and glandular atrophy. Although rare, AVMs should be considered a differential diagnosis for a submandibular gland mass that gives unclear or unusual radiological appearances.

Buccal vascular malformation with multiple giant phleboliths: a rare case presentation and review of the literature

PURPOSE

The purpose of this study was to describe a case and to review the diameters, symptoms, locations, and treatment methods for vascular malformations (VMs) with phleboliths. Our case report is probably the first to mention this observation because of sizes and large number of phleboliths in buccal region.

CASE PRESENTATION

A 26-year-old male patient was referred to Ordu University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery for the evaluation and management of a painless tender swelling in the left buccal region. Clinically, a bluish mucosal lesion of the posterior region of the left buccal mucosa and lip is apparent. Panoramic radiography and CT were obtained for radiographical examinations. Multiple giant phleboliths with the largest dimension of 32 mm were seen in this region. Left maxillary first molar teeth extraction was indicated. An aspiration was performed and revealed that there is a risk of severe hemorrhage. The patient did not want to take MRI and stated that he only wanted to have dental treatment. Therefore, it was decided that the maxillary first molar should be retained in the region and endodontic treatment should be done, if necessary.

CONCLUSIONS

The clinic of phlebolith patients is painless swelling and can reach up to 6 cm. The localization is not specific but is found in the masseter and parotid regions generally. Treatment may be invasive or non-invasive depending on, location, accessibility, depth of invasion, age, cosmetic issues, and risk of severe hemorrhage, as with the current case.

A Solitary Phlebolith in the Buccal Mucosa: Report of a Rare Entity and Clinicopathologic Correlation

Pathological conditions can give rise to calcifications within oral mucosa representing either a local or systemic disturbance. Inflammation, trauma, debris acting as nidus and vascular lesions have been attributed as principal causes for occurrence of calcifications within the oral mucosa. Occurrence of multiple calcified thrombi (phleboliths) is considered pathognomonic for hemangiomas and vascular malformations in the oral and maxillofacial region. Isolated occurrence of phlebolith in oral mucosa though very rare, especially without any underlying vascular lesions, can be diagnostically challenging. Either a traumatic association at that site or a hemangioma of childhood that has regressed once the individual became an adult are the possible explanations suggested for the occurrence of these unique solitary phleboliths. Histologically, an "onion-ring"-like concentric lamellar fibrosis around a central core with varying amounts of calcifications and presence of minute vascular channels within or around calcified lamellae is characteristic for phlebolith. There is a high propensity for misdiagnosing solitary phlebolith located in sites like the buccal mucosa where various other pathologic soft-tissue calcifications, such as sialoliths, calcified lymph nodes, traumatic myositis ossificans, etc. can occur and they too appear radiopaque in radiographs. Besides, the absence of any associated underlying vascular lesion adds to the mispercep-tion. In such cases, histopathological examination with routine hematoxylin and eosin staining alone may not be sufficient to determine the accurate diagnosis. Allied clinical history and immunohistochemistry can aid to arrive at the final diagnosis. We report such a case of nonvascular lesion-associated solitary phlebolith in the right buccal mucosa of a healthy 49-year-old male patient and discuss its differential diagnosis with emphasis on histological presentation.