Highlights • Intraosseous venous malformations of the zygoma is rare. • Venous malformations are often misrepresented as “hemangiomas”. • Preoperative arteriography and embolization are necessary for diagnosis and hemorrhage control during operation. • En-bloc resection and primary reconstruction of the lesion is important to prevent recurrence and postoperative malar irregularity. • For reconstruction, calvarial bone graft is optimal for maintaining malar contour. Introduction Venous malformations of the zygoma are rare. Historically, venous malformations have been misrepresented as “hemangiomas”. The International Society for the Study of Vascular Anomaly (ISSVA) classification is a reasonable classification that leads to appropriate clinical diagnosis and treatment strategies. Collaboration between surgeons, radiologists, and pathologists is necessary for accurate diagnosis and management. Presentation of case We present here a case of an IOVM in a 59-year-old woman who was treated with a multidisciplinary approach. Superselective arteriography and embolization were effective for diagnosis as well as for prevention of large hemorrhage during surgery. En-bloc resection of the zygoma was performed within hours after embolization and autologous calvarial bone graft was used for primary reconstruction. Discussion We performed a literature review consisting of reviewing 52 cases of IOVM of the zygoma discussing optimal material for reconstruction of the defect for intraosseous venous malformation of the zygoma nationally and internationally. Conclusion The combination of surgery and preoperative angiography makes it possible to prevent high risk of hemorrhage. For primary reconstruction of the zygoma, use of autologous calvarial bone can maintain the volume and reconstruct the natural malar contour.
