Extremely Rare Case of Cavernous Haemangioma of Submandibular Gland

Haemangioma or hemangioendothelioma is amongst the commonest developmental, vascular lesions of infancy and childhood. Hemangioendothelioma of the salivary glands, however, is extremely rare. Due to their rarity, they may be misdiagnosed as lymphangiomas or other cystic lesions found more commonly in the region. This may lead to surgical complications including torrential hemorrhage that may have dire consequences for the patient.

Case Report: 

Herein we present the case of a nine-year-old male with a cavernous haemangioma involving the left submandibular gland which was diagnosed on-table due to inconclusive pre-operative radiological and pathological diagnosis. Fortunately, due to meticulous dissection and care the lesion was excised in toto without any significant blood loss. 

Haemangioma of the submandibular gland is so uncommon that often it isn't even considered a differential diagnosis for cystic swellings and lesions in this region. Mistaken diagnoses preoperatively may prove disastrous for the patient.  Excision of haemangiomas requires planning for hemostasis and blood loss if it occurs. Even minor iatrogenic manipulation of vascular lesions may completely obscure the field due to bleeding, making dissection and recognition of anatomical landmarks very difficult. This is especially dangerous in the submandibular region due to the proximity of various vital vascular and neural elements. A differential of haemangioma should therefore always be considered by surgeons and radiologists alike for lesions with suspicious or indeterminate features, in this region.