Eur J Plast Surg (1998) 21:129±131
lan ´ H. AkbasË ´ L. Erog
lu ´ N. Turan
A. Demir ´ I. Yavuz
Intramuscular vascular malformation
of the infrazygomatic and temporal fossa
Received: 25 March 1997 / Accepted: 2 June 1997
) ´ H. AkbasË ´ L. Erog
lu ´ N. Turan
A. Demir ´ I. Yavuz
Division of Plastic and Reconstructive Surgery,
Ondokuzmayis Faculty of Medicine, Samsun, Turkey
P. K. 207, Samsun, Turkey
Abstract Intramuscular vascular anomalies are uncom-
mon tumors in the head and neck region. The majority
are in the masseter and trapezius, but they are rare in
the temporal muscle. A rare case of an intramuscular vas-
cular malformation of the temporalis muscle is reported.
The clinical presentation, radiographic and histologic
findings, treatment and outcome of this patient are pre-
Key words Intramuscular mass ´ Intramuscular vascular
malformation ´ Temporal muscle
Intramuscular vascular malformations of the head and
neck are rare. These lesions originate in the skeletal mus-
cle and represented less than 1% of all vascular anomalies
. The majority of the intramuscular vascular malforma-
tions of the head and neck have been reported in the mas-
seter and trapezius, but they are very rare in the tempora-
lis muscle [1, 2].
Its rare location, difficult preoperative diagnosis, and
successful treatment make the present case worthy of pre-
A 24-year-old, otherwise healthy man, presented with the complaint
of a swelling in the left temporal fossa (Fig. 1). There was no history
of trauma. He noted gradual enlargement over the last three years.
Physical examination revealed a smooth, round, soft, nontender
and noncompressible mass with a well-defined edge measuring
34 cm and located deep to the zygomatic arch and temporal fossa.
There was no palpable thrill or audible bruit. The physical examina-
tion was otherwise unremarkable. Routine laboratory evaluation was
Computerized tomography identified an enhancing well-circum-
scribed mass in the left temporal area deep to the zygomatic arch
with no bone invasion or intracranial extension (Fig. 2). Plain X-
ray films were normal.
With a preoperative diagnosis of lipoma and under general anes-
thesia, a skin incision was made from the temporal region to the pre-
auricular region, this was taken down to the deep temporalis fascia.
The fascial cut was perpendicular to the root of the zygomatic arch
and was extended superiorly at a 45 angle. The fascial layer was
elevated over the temporalis muscle, and it could now be seen that
the mass lay deep to the zygomatic arch and extended into the tem-
poral muscle. The mass was bluntly dissected, no large feeding ves-
sel was encountered. The mass was excised totally (Fig. 3). The
wound was closed in layers and a vacuum drain was left in position
for two days.
The cut surface of the specimen showed a whitish, well-circum-
scribed tumor measuring 34 cm. Histopathological examination
showed numerous dilated and congested vascular structures, the di-
agnosis being a venous malformation (Fig. 4).
After eight months of follow-up the patient was well, with nor-
mal function of the temporal muscle and mandible with no evidence
of recurrent disease.
Intramuscular vascular malformations are benign, con-
genital neoplasms. Although any muscle can be affected,
the majority of intramuscular vascular malformations oc-
cur in the lower limbs, particularly the muscles of the
thigh . Approximately 15±20% of all intramuscular
vascular anomalies arise in the head neck muscles, with
the masseter being most commonly affected . Vascular
malformation of the masseter was described in 1930 and
since then 76 cases have been reported , in contrast, the
temporalis muscle is a rare site [1, 2].
These lesions are often asymptomatic, they usually
present only as a mass which is usually soft, smooth,
and nontender. Overlying skin discoloration is rare. The
rarity of the lesion causes it to be ignored as a differential
diagnosis, and it is commonly confused with benign or
malignant neoplasms [1, 3]. Accurate preoperative diag-