Intramuscular M.
J. Ghan,
N.
haemangioma R. McLean,
J. V.
of the orbicularis
oris muscle
Soames
Department of‘Plastic Surgery, Newcastle Generul Hospitul, Newcustle upon Tytle untl Depurtment 01 Oral Pathology, University of Ncwcusrle upon 7j,ne
SUMMARY. The intramuscular haemangioma is a relatively uncommon benign vascular tumour which accounts for less than 1% of all haemangiomas. It is a rare lesion in the orofacial muscles. A case is reported arising in the orbicularis oris muscle presenting in a 9-month-old child.
INTRODUCTION
Case report
Intramuscular hacmangioma is an uncommon angiomatous malformation affecting mainly the upper and lower extremities. It is a benign condition usually presenting in childhood or early adult life. is trcatablc by complete surgical excision and carries an excellent prognosis (Enzinger & Weiss, 1088). It is a rare lesion in the head and neck region (Scott, 1957) and a search of the literature had revealed only two other cases arising in the orbicularis oris muscle (Ivy rt (11.. 1980; Kinni et al.. 1981) to which WC wish to add a third.
A 9-month-old child presented with a painless 1.5 cm diamctcr rubhcry hard swelling in the upper lip which had been noted from birth (Figs IA/B). It was slowly increasing in size and interfered with the infant’s ability to suckle satisfactorily. The lesion was mobile. not attached to overlying skin or mucosa, non-pulsatile and there was no overlying skin discolouration. A provisional diagnosis of mucous cyst was made. The lesion was removed by surgical excision under gcncral anaesthesia. At operation a dull red. firm. ill-defined tumour-like mass was identified within the substance of the orbicularis oris muscle. Hacmostasis was achieved by bipolar diathermy to a fc\y oozing points but there was no major haemorrhagc. I listopathological examination showed a multinodutar. tumour-like lesion consisting of disorganised masses of predominantly small capillary-like blood vessels with
Fig. I-(A~~ndH)(~linicalappcar~~ncco~~heswcllingi~~thclcft upperlip.
Fig.2-Photomicrographofintr;lmuscularh;Icmangiomashowing in;~inl~sm;~llvcssclsandoccasion;~lI;~r~ecavernoussp;~ces (topof ficld). (I I K:IT.Original magnification x60).
Fi~.3-lntr;~mu~cularhacmangiomashowingpcrineuralvcss~ls (arrows). (H &E. Original m:lgnific;ltionx2tM)).
occasional larger vessels and cavernous spaces. In dccpcr ;wcas. abnormal vessels ramified amongst muscle hundlcs (I:ig. 2) and in a few place they were identified within pcrineural sheaths (Fig. 3). The Icsion was diagnosed as :l mixed-type of intramuscular haemangioma.
Intramuscular
hacmangioma
is a rare
lesion account-
ing for less than 1% of all hacmangiomata (Watson & McCarthy. lY40). The majority occur in the muscles of the upper and lower extremities, particularly in the muscles of the thigh (Enzinger & Weiss. 1988) and nearly half of them present during the first decade of life; 94% occur before the age of 30 years (Jenkins & Delaney, 1932). Thcrc is no sex prcdilcction. About 13% of intramuscular hacmangiomas occur in the head and neck region (Scott, lY57). In the orofacial region, they arc mainly located in the masseter muscle (Chipps & Wcilcr. lY50: Conley Xr Clairmont. 1977; Sat0 et (il.. lY7Y). Rarer sltcs include the orbicularis oris (Ivy et al.. 1980; Kinni CI ul., IYXl). digastric and mylohyoid muscles (Rriggs . (lY40). Bloodandlymph vessel tumours. Sftrgcry. Gynecology und Ohsrc/ric.v. 71,
fIri/i.sh
Paper rcccived I October IYY I Accepted 30 October 1901
for offprints to N. R. Mclean
SW.
J. Ghan,
N.
haemangioma R. McLean,
J. V.
of the orbicularis
oris muscle
Soames
Department of‘Plastic Surgery, Newcastle Generul Hospitul, Newcustle upon Tytle untl Depurtment 01 Oral Pathology, University of Ncwcusrle upon 7j,ne
SUMMARY. The intramuscular haemangioma is a relatively uncommon benign vascular tumour which accounts for less than 1% of all haemangiomas. It is a rare lesion in the orofacial muscles. A case is reported arising in the orbicularis oris muscle presenting in a 9-month-old child.
INTRODUCTION
Case report
Intramuscular hacmangioma is an uncommon angiomatous malformation affecting mainly the upper and lower extremities. It is a benign condition usually presenting in childhood or early adult life. is trcatablc by complete surgical excision and carries an excellent prognosis (Enzinger & Weiss, 1088). It is a rare lesion in the head and neck region (Scott, 1957) and a search of the literature had revealed only two other cases arising in the orbicularis oris muscle (Ivy rt (11.. 1980; Kinni et al.. 1981) to which WC wish to add a third.
A 9-month-old child presented with a painless 1.5 cm diamctcr rubhcry hard swelling in the upper lip which had been noted from birth (Figs IA/B). It was slowly increasing in size and interfered with the infant’s ability to suckle satisfactorily. The lesion was mobile. not attached to overlying skin or mucosa, non-pulsatile and there was no overlying skin discolouration. A provisional diagnosis of mucous cyst was made. The lesion was removed by surgical excision under gcncral anaesthesia. At operation a dull red. firm. ill-defined tumour-like mass was identified within the substance of the orbicularis oris muscle. Hacmostasis was achieved by bipolar diathermy to a fc\y oozing points but there was no major haemorrhagc. I listopathological examination showed a multinodutar. tumour-like lesion consisting of disorganised masses of predominantly small capillary-like blood vessels with
Fig. I-(A~~ndH)(~linicalappcar~~ncco~~heswcllingi~~thclcft upperlip.
Fig.2-Photomicrographofintr;lmuscularh;Icmangiomashowing in;~inl~sm;~llvcssclsandoccasion;~lI;~r~ecavernoussp;~ces (topof ficld). (I I K:IT.Original magnification x60).
Fi~.3-lntr;~mu~cularhacmangiomashowingpcrineuralvcss~ls (arrows). (H &E. Original m:lgnific;ltionx2tM)).
occasional larger vessels and cavernous spaces. In dccpcr ;wcas. abnormal vessels ramified amongst muscle hundlcs (I:ig. 2) and in a few place they were identified within pcrineural sheaths (Fig. 3). The Icsion was diagnosed as :l mixed-type of intramuscular haemangioma.
Intramuscular
hacmangioma
is a rare
lesion account-
ing for less than 1% of all hacmangiomata (Watson & McCarthy. lY40). The majority occur in the muscles of the upper and lower extremities, particularly in the muscles of the thigh (Enzinger & Weiss. 1988) and nearly half of them present during the first decade of life; 94% occur before the age of 30 years (Jenkins & Delaney, 1932). Thcrc is no sex prcdilcction. About 13% of intramuscular hacmangiomas occur in the head and neck region (Scott, lY57). In the orofacial region, they arc mainly located in the masseter muscle (Chipps & Wcilcr. lY50: Conley Xr Clairmont. 1977; Sat0 et (il.. lY7Y). Rarer sltcs include the orbicularis oris (Ivy et al.. 1980; Kinni CI ul., IYXl). digastric and mylohyoid muscles (Rriggs . (lY40). Bloodandlymph vessel tumours. Sftrgcry. Gynecology und Ohsrc/ric.v. 71,
fIri/i.sh
Paper rcccived I October IYY I Accepted 30 October 1901
for offprints to N. R. Mclean
SW.
