1) A young man presented with a painless bulging near the left angle of the jaw. MRI revealed a left intramuscular lipoma within the masseter muscle. Lipomas are common soft tissue tumors that are rarely found in the oral and maxillofacial region. 2) A young woman had a painless mass located near the left angle of the jaw that increased in size with teeth clenching. MRI findings were consistent with an intramuscular hemangioma arising from the masseter muscle. 3) Lipomas and other benign soft tissue lesions in the oral cavity are typically asymptomatic and can be diagnosed with imaging such as MRI. The treatment for these lesions is surgical excision.

1. FRANÇOISE HERAN
Fondation Rothschild - Paris
GUY PRINC
Hôpital St Joseph – Paris
JFIM Barcelona nov 2014

2. THE ANGLE OF THE JAW

3. LEFT INTRAMASSETER LIPOMA
Tsumuraya G, Yamada H, Shimizu H, Hamada Y Intramuscular lipoma in the masseter muscle: a case report. Br J Oral Maxillofac
Surg.2014 Apr;52(4):e21-3. doi: 10.1016/j.bjoms.2014.01.013. Epub 2014 Feb 17.
Young man complaining of a painless focal bulging of the le3 angle of the jaw. No trauma,
known for a long ;me…but doesn’t feet anymore the long hair. MRI requested (presurgery
evalua;on).
This is the first report to our knowledge of an intramuscular lipoma that arose in the masseter
muscle….. They are joking !
MY QUESTION : HOW DO YOU TREAT THIS LESION ?

4. LIPOMA

5. Lipomas and lipoma variants common soft tissue tumors
Rare in the oral and maxillofacial region.
¾ Male
Parotid region >buccal mucosa >lip > submandibular region > tongue
> palate > floor of mouth > vestibule
Asymptomatic, circumscribed mass
Histology : 20% intramuscular.
classic lipomas, spindle cell/pleomorphic lipomas, chondroid lipoma.
Secondary changes : fat necrosis, atrophy, and prominent
hyalinization, should not be confused with the malignant histologic
features of a liposarcoma.
Furlong MA, Fanburg-Smith JC, Childers EL Lipoma of the oral and maxillofacial region: Site and subclassificaFon of 125 cases. Oral Surg Oral
Med Oral Pathol Oral Radiol Endod.2004 Oct;98(4):441-50.

6. Young woman with a history of painless mass located near the leW
angle of the jaw, with increased volume during teeth clenching

7. INTRA MASSETER HEMANGIOMA

8. Intramuscular hemangioma (HM) :
congenital hamartomatous neoplasm,
proliferaFon of benign vascular channels.
1% of all HM
20 % of intramuscular HM : located in the head and neck muscles
(masseter, trapezius).
OWen young male (<30 yo).
MRI :
high HS T2, punctuate or reFculate low signal on T1 and T2, focci of
very low signal (phleboliths).
Heterogenous enhancement.
Intramuscular cavernous hemangioma arising from the masseter muscle. Righini CA, Berta E, Atallah I. Eur Ann
Otorhinolaryngol Head Neck Dis. 2014 Feb;131(1):57-9

9. THE TONGUE

10. HEMANGIOMA OF THE TONGUE

11. THE CHEEK

12. Painless swelling the leW cheek.

13. MANDIBULAR CYST

14. 2013
Young boy with brackets, undergoing a systemaFc control.
Progressive swelling the right cheek.
Pre treatment and recent dental panoramic radiography
2014

15. RIGHT DENTIGEROUS CYST
MRI ?
A wide black hole on every sequence..

16. epithelial-lined structures derived from odontogenic epithelium.
Periapical cyst
Dentigerous cyst
well-demarcated radiolucent lesion attached at an acute angle to the cervical
area of an unerupted tooth
patient at risk for pathologic jaw fracture
primordial cyst
Develops instead of a tooth
Residual cyst
Lateral periodontal cyst
Gingival cyst
Odontogenic keratocyst (keratocystic odontogenic tumor)
Aggressive , difficult to remove.
Gorlin sydrome
Basal cell nevus syndrome

17. Painless focal swelling of the leW cheek for a few weeks according
to the paFent. Could be present for a long Fme ?? She doesn’t
know. MRI is performed.

18. T1

19. T2 FATSAT

20. DIFFUSION
B1000 ADC
It could be a Stensen duct dilataFon

21. PLEOMORPHIC ADENOMA
Lesion of the paroFd gland, even if cyst like : diffusion, injecFon
Capaccio P, Cuccarini V Ocaviani F Minorad D, Sambataro G, Cornalba P Pignataro L Comparadve
ultrasonographic, magnedc resonance sialographic, and videoendoscopic assessment of salivary duct disorders. Ann Otol
Rhinol Laryngol.2008 Apr;117(4):245-52.
T1 Gd
FATSAT

23. FOREIGN BODY

24. THE CHEEKBONE

25. Mrs T, 62 YO complains of small areas of swelling appeared two
months ago, more obvious on the right side. She has no history
of trauma, and general examinaFon is otherwise normal.
T1

26. T2 FATSAT
DIFFUSION
T1 Gd
FATSAT
INJECTABLE SOFT-TISSUE FILLER (HYALURONIC ACID)

27. Schatz CJ, Ginat DT Imaging of cosmetic facial implants and grafts. AJNR Am J Neuroradiol.2013
Sep;34(9):1674-81. doi: 10.3174/ajnr.A3214. Epub 2012 Aug 9.
Daines SM, Williams EF Complicadons associated with injectable sog-dssue fillers: a 5-year retrospecdve review.
JAMA Facial Plast Surg. 2013 May;15(3):226-31. doi: 10.1001/jamafacial.2013.798.
Complications associated with injectable soft-tissue filler
hyaluronic acid
poly-L-lactic acid
calcium hydroxylapatite.
0,8 % complications
most common nodule or granuloma formation.
calcium hydroxylapatite : highest complication rate.
Main differential diagnosis : lower lid lymphoma
Diffusion, injection.

28. THE SUBMENTAL AREA

29. DERMOID CYST

30. Dermoid cysts : variation of teratomas arise
from entrapment of epithelial remnants either
During closure of the branchial arches
As a result of trauma.
Floor of the mouth = 1/5 of the head and neck
dermoid cysts
è tongue elevation, submental protrusion, or
both. young persons,
Differential diagnosis
lipoma,
branchial cleft cysts
thyroglossal duct cysts
Baliga M, Shenoy N, Poojary D, Mohan R, Naik R Epidermoid cyst of the floor of the mouth . Natl J Maxillofac Surg. 2014 Jan;5(1):79-83.

31. THE SUBMANDIBULARY AREA

32. Mrs V, 36 YO has a chronic swelling of the floor of the mouth
combined with a recent bulging of the right submental area. MRI
is performed.
T1

33. PLUNGING RANULA
T2 FATSAT
MR SIALOGRAPHY

34. Li J, Li J Correct diagnosis for plunging ranula by magneFc resonance imaging. Aust Dent J.2014 Jun;59(2):264-7.
Plunging ranula
rare : mucous extravasation extending through or behind the
mylohyoid muscle.
swelling in the submental or submandibular regions due to
disruption of excretory sublingual gland ducts.
Definitive treatment :
Resection of the ipsilateral sublingual gland
Evacuation of the cyst
Differential diagnosis
Abscesses
Thyroglossal cyst or simple cysts
Lipoma.
Second branchial cleft cyst

35. Plunging ranula recurrence after surgery
T2 FATSAT T1 Gd FATSAT
MR SIALOGRAPHY

37. Agarwal AK, Kanekar SG Submandibular and sublingual spaces: diagnostic imaging and evaluation. Otolaryngol
Clin North Am.2012 Dec;45(6):1311-23. doi: 10.1016/j.otc.2012.08.005.
SECOND BRANCHIAL CLEFT
CYST

38. THE FACE

39. Mrs V, 42 YO has a very thin and flat face. She describes episodes
of legs nodules.

40. T2 FATSAT
T1

41. T1

42. Rare type of panniculiFs (inflammatory disease of the
subcutaneous faky Fssue ).
Acute relapsing episodes with unknown eFology, fever with chills
off and on, arthralgia, general symptoms
WEBER-CHRISTIAN SYNDROME
.Negalur VG, Negalur BV Weber Christian disease. J Assoc Physicians India.2003 Jul;51:724-5

44. Rare
Ethiopathogeny ?
Neurologiqal symptomes : seizures
MRI: sometimes atrophy or white matter hyperintensity
(localized meningoencephalitis with vascular involvement ?)
Other diagnosis
Sclerodermia.
PARRY ROMBERG SYNDROME
Parry-Romberg syndrome: intracranial MRI appearances. J Craniomaxillofac Surg.2003 Oct;31(5):321-4.
Moko SB Mistry Y Blandin de Chalain TM

45. LocaFon
DuraFon
History

46. LeW cheek very progressive swelling
MRI : chronic paroFdis ?

48. Etiology suggested
Temporomandibular disorders,
Gum chewing
Psychological disorders including anxiety
Differential clinical diagnosis
parotid gland diseases
dental and jaw pathology,
muscle tumors and intrinsic masseter
muscle myopathy

49. Same disease, bilateral