eRadiograph Volume 7: Imaging of Oral Cavity | Page 200
fluid/fluid levels may be present particularly when internal haemorrhage has occurred
or due to debris following infection. There is usually no enhancement with contrast,
occasionally the septa enhance. MRI is particularly useful as it delinates the extent as
well as encasement of adjacent structures. Surgery is the ideal means of treatment
though lesions which are extensive and complex, sclerotherapy may be performed.
Mixed venolymphatic malformations – in these malformations there are both
venous and lymphatic components. The venous components appear as venous
malformations and enhance whereas the lymphatic components do not.
Arteriovenous Malformations
These consist of an arterial feeder and a venous drainage component. These are high
flow lesions as a result on doppler high flow will be demonstrated.On CT/MRI- the
vascular channels are seen as serpiginous enhancing structures on CT/post contrast
MRI and flow voids on non contrast MRI. The ideal treatment is embolisation of the
arterial feeder.
Vascular neoplasms:
1) Haemangioma
2) Carotid body tumors
3) Glomus jugulare
4) Juvenile nasopharyngeal Angiofibroma
These are neoplastic so their growth is independent of body size.
Imaging is required to delinate the extent of the lesion as well as its anatomical
location. On imaging they appear as well defined densely enhancing lesions. On MRI
they are isointense on T1W1, hyperintense on T2W1 and enhance densely
with contrast. These are high flow lesions demonstrating flow on color
doppler. On angiography they demonstrate an arterial blush with persistence
of contrast.
Haemangiomas are self involuting lesions – the best management is expectant
management – intervention is done only when they compromise the function of
important structures due to local pressure or for cosmetic reasons. These lesions may
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Masticator Space
Haemangioma
These are benign vascular neoplasm representing one of the most common tumors
seen in infancy. (70% at birth, 87% in first month of life). These tend to be small or
absent at birth, after birth they undergo a proliferative phase with rapid growth over
several months, then they undergo a stationary period and finally involute. Vascular
malformations on the other hand are always present at birth and enlarge in proportion
to growth of the child. They do not involute and remain present through life.