Temporalis Muscle Cavernous Hemangioma in a Pediatric Patient

Abstract

Background: Temporalis muscle hemangiomas are an uncommon entity, even among the rare incidences of intramuscular hemangiomas. They are frequently identified as round, painless, soft lesions beneath the skin that have been growing slowly over time. A preliminary diagnosis can be made based on magnetic resonance imaging, but it is confirmed by pathology of the surgically excised lesion. The safest practice is to resect all of the hemangioma plus a safe margin of normal muscle so as to prevent recurrence as much as possible. Watchful waiting is also a reasonable alternative when surgery is not indicated.

Case presentation: Because of the apparent paucity of this lesion, especially in the pediatric population, we report this case of a temporalis muscle cavernous hemangioma in a male under 18 years of age who presented for a growing, painful temporalis lesion 4 years after being managed conservatively.

Conclusion: Temporalis hemangiomas are among the rarest intramuscular hemangiomas (IMHs) reported in the pediatrics population. They are often misdiagnosed, with MRIs being the preferred imaging for preoperative diagnosis, and a CT can determine bony involvement. The superior method of treatment when not simply observing its progress is wide surgical excision with normal muscle borders preceded by embolization for better bleeding control. IMHs do not have very high recurrence rates, but re-operation is feasible and none was shown to metastasize.