Essentials of surgical treatment for intramasseteric hemangioma.

Although rare, surgical treatment may become necessary for patients with intramasseteric hemangiomas. Possible bleeding, neural injury or postoperative dysfunction are factors limiting surgical approaches. We present the following surgical highpoints for tumors involving the masseter muscles. These include careful preoperative planning with computed tomography and magnetic resonance imaging, as well as a surgical approach that provides adequate exposure for optimal tumor resection and identification of vital anatomic structures. In particular, care must be taken to preserve branches of the facial nerve. In certain cases, preoperative embolization or ligation of vessels feeding tumor helps to minimize blood loss. Whenever possible, complete tumor should be adequately resected with a surrounding margin of normal muscle. Postoperative lymphedema can be minimized by preserving the mandibular periosteum and oral or parenteral use of medication with anti-inflammatory agents. At the University of Tokyo, continuous suction is preferred with a fenestrated drain or pressure dressing with a Penrose drain should be applied to prevent hematoma. Postoperative dysfunction, such as trismus, is prevented by supportive measures.