Presentation
Boxer with tender left left cheek swelling. Fracture? Hematoma?
Patient Data
A heterogenous soft tissue density lesion is seen anterior to the left masseter muscle.
The lesion extends posterosuperiorly to lie anterolateral to the pterygoid muscles and lateral to the left alveolar maxillary ridge. It possess a low signal on T1 and high signal on T2. There is heterogeneous post-contrast enhancement. No bone destruction. No diffusion restriction.
The lesion extends into and expands the pterygomaxillary fissure and pterygopalatine fossa. Dilated feeding vessels are seen arising from the left facial and maxillary arteries. Venous drainage is to the facial vein.
There is no orbital or intracranial extension.
Case Discussion
AVMs are rare congenital vascular malformations. Half occur in the oral and maxillofacial region. Management consists of surgery, vascular embolization or both.
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