Clinical and radiologic features of submandibular triangle hemangioma

The clinical and radiologic features of submandibular triangle hemangioma have not been systematically reported. Hemangiomas in the submandibular triangle are very rare and are often misdiagnosed as other benign cystic masses or inflammatory conditions.

We retrospectively reviewed the medical records of 5 patients who underwent surgery for submandibular triangle hemangioma between January 2006 and April 2011.

All patients presented with fluctuating swelling with or without pain in the submandibular triangle. Computed tomographic (CT) scans showed cystic masses around the submandibular glands and calcified nodules in the lesions. Ill-defined vascular lesions and variably sized hard nodules were identified during surgery. Bleeding was controlled by early ligation of feeding vessels. The submandibular gland was removed for surgical exposure in 4 patients. Pathologic review of each specimen revealed that all were cavernous hemangiomas with thrombosis and phleboliths. Complications included 1 temporary marginal mandibular nerve paresis and 1 postoperative hematoma. No recurrence after surgery was seen during a follow-up period of 4 to 52 months.

The possibility of submandibular triangle hemangioma should first be considered when a cystic mass around the submandibular gland and multiple calcifications are present on CT. Ligation of feeding vessels and resection of the submandibular gland may be needed to obtain surgical exposure and prevent massive bleeding.