Reconstruction of intraosseous hemangiomas of the midface using split calvarial bone grafts

BACKGROUND: Intraosseous hemangiomas are benign lesions that usually occur in the vertebral column and the calvaria. They are rare in the midface, with only 22 zygomatic and 26 nasal bone hemangioma cases described in the literature. Methods of reconstruction of craniofacial defects after surgical removal of these tumors have been inconsistent. METHODS: The authors report long-term follow-up in three cases of midface intraosseous hemangiomas all treated in a similar fashion: surgical excision of the tumor with a small margin of normal bone and primary reconstruction using split calvarial bone grafts. RESULTS: Clinical, photographic, and computed tomographic assessment (cases 1 and 2) documents no recurrence and maintenance of the result with a mean 5-year follow-up. To the authors' knowledge, this represents the longest follow-up of a patient series with hemangiomas of bone treated with primary reconstruction in the plastic surgery literature (Wolfe and Berkowitz did report on a single case with 4-year follow-up without recurrence). We recommend replacing like with like. Primary bone grafting with autogenous cranial bone was used to replace areas where original bone was thin, but full-thickness bone was used in areas where original bone was thick. Full-thickness cranial bone grafts may be superior to split cranial bone with regard to long-term volume maintenance. CONCLUSIONS: Preoperative computed tomographic scanning should lead to the appropriate diagnosis. Proper diagnosis should lead to appropriate treatment, which includes total excision and primary bone grafting of the defect to prevent soft-tissue contraction. Copyright ©2006 by the American Society of Plastic Surgeons.