Varix of the facial vein.

The differential diagnosis for a mass overlying the angle of the mandible but not attached to it includes lymphatic masses, benign and malignant parotid lesions, cysts, and vascular malformations. Thrombosis of the facial vein is a rare entity that now must be added to the list. This article details the first English-language description of such a thrombosis presenting as a mass. The possible causes are antecedent trauma, infection, or thrombosis of contiguous venous structures. While the diagnosis could be made preoperatively by selective venography or ultrasonography, it most likely will be made by surgical excisions. The preoperative diagnosis may be suggested by the "turkey wattle sign" (i.e., fluctuation in the size of the mass with bending the head downward). In this article the entity and differential diagnosis are reviewed and discussed.