Intramuscular Hemangioma Misdiagnosed as Unilateral Masseter Hypertrophy: A Case Report

  • Lee, So-Youn (Department of Oral Medicine, School of Dentistry, Kyungpook National University) ;
  • Byun, Jin-Seok (Department of Oral Medicine, School of Dentistry, Kyungpook National University) ;
  • Jung, Jae-Kwang (Department of Oral Medicine, School of Dentistry, Kyungpook National University) ;
  • Choi, Jae-Kap (Department of Oral Medicine, School of Dentistry, Kyungpook National University)
  • Received : 2016.02.24
  • Accepted : 2016.03.04
  • Published : 2016.03.30


Intramuscular hemangioma is a rare type of hemangiomas and sometimes overlooked by orofacial pain specialist who encountered various types of masticatory muscle problems. A 42-year-old male, presented with feeling of unilateral hypertrophy on left mandibular area, is finally diagnosed as hemangioma with thrombus by excisional biopsy. However, he was initially treated by injection of botulinum toxin A due to misdiagnosis as unilateral masseter hypertrophy. In the present report, we remind the importance of careful examination and diagnostic images to orofacial pain clinicians in early detection of intramuscular hemangioma of masticatory muscles.


  1. Yeo CK. Cavernous hemangioma of the masseter muscle. Korean J Otolaryngol-Head Neck Surg 2006;49:669-671.
  2. Rossiter JL, Hendrix RA, Tom LW, Potsic WP. Intramuscular hemangioma of the head and neck. Otolaryngol Head Neck Surg 1993;108:18-26.
  3. Kleinman ME, Greives MR, Churgin SS, et al. Hypoxia-induced mediators of stem/progenitor cell trafficking are increased in children with hemangioma. Arterioscler Thromb Vasc Biol 2007;27:2664-2670.
  4. Barnes CM, Huang S, Kaipainen A, et al. Evidence by molecular profiling for a placental origin of infantile hemangioma. Proc Natl Acad Sci U S A 2005;102:19097-19102.
  5. Narayanan CD, Prakash P, Dhanasekaran CK. Intramuscular hemangioma of the masseter muscle: a case report. Cases J 2009;2:7459.
  6. Odabasi AO, Metin KK, Mutlu C, Basak S, Erpek G. Intramuscular hemangioma of the masseter muscle. Eur Arch Otorhinolaryngol 1999;256:366-369.
  7. Allen PW, Enzinger FM. Hemangioma of skeletal muscle. An analysis of 89 cases. Cancer 1972;29:8-22.<8::AID-CNCR2820290103>3.0.CO;2-A
  8. Mitty HA, Kleiger B. Partial embolization of large peripheral hemangioma for pain control. Radiology 1978;127:671-672.
  9. Kanaya H, Saito Y, Gama N, Konno W, Hirabayashi H, Haruna S. Intramuscular hemangioma of masseter muscle with prominent formation of phleboliths: a case report. Auris Nasus Larynx 2008;35:587-591.
  10. Hart B, Schwartz HC. Cavernous hemangioma of the masseter muscle: report of a case. J Oral Maxillofac Surg 1995;53:467-469.
  11. Rogalski R, Hensinger R, Loder R. Vascular abnormalities of the extremities: clinical findings and management. J Pediatr Orthop 1993;13:9-14.
  12. Choi JH, Park SW, Chung HY, et al. Incidental aggravation of venous malformation after botulinum toxin type a injection for reducing benign masseteric hypertrophy. Dermatol Surg 2010;36(Suppl 4):2188-2192.
  13. Kim DH, Hwang M, Kang YK, Kim IJ, Park YK. Intramuscular hemangioma mimicking myofascial pain syndrome: a case report. J Korean Med Sci 2007;22:580-582.
  14. Koh JW, Oh JH, Shin JC, Kim SY. Case report: intramasseteric vascular anomaly-misdiagnosed to parotid sialolithiasis. Korean J Otolaryngol-Head Neck Surg 1999;42:380-385.
  15. Lee SK, Kwon SY. Intramuscular cavernous hemangioma arising from masseter muscle: a diagnostic dilemma (2006: 12b). Eur Radiol 2007;17:854-857.
  16. Mandel L, Surattanont F. Clinical and imaging diagnoses of intramuscular hemangiomas: the wattle sign and case reports. J Oral Maxillofac Surg 2004;62:754-758.
  17. Altug HA, Buyuksoy V, Okcu KM, Dogan N. Hemangiomas of the head and neck with phleboliths: clinical features, diagnostic imaging, and treatment of 3 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:e60-e64.
  18. Zengin AZ, Celenk P, Sumer AP. Intramuscular hemangioma presenting with multiple phleboliths: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:e32-e36.
  19. Memis A, Arkun R, Ustun EE, Kandiloglu G. Magnetic resonance imaging of intramuscular haemangiomas with emphasis on contrast enhancement patterns. Clin Radiol 1996;51:198-204.
  20. Morris SJ, Adams H. Case report: paediatric intramuscular haemangiomata: don't overlook the phlebolith! Br J Radiol 1995;68:208-211.