Phleboliths as Diagnostic Clues: Unravelling a Venous Malformation of the Masticator Space

Venous malformations of the oral and maxillofacial region are uncommon and may remain clinically undetected for several years due to their slow-growing and relatively asymptomatic nature. A comprehensive clinical examination supported by appropriate imaging modalities, including Colour Doppler ultrasonography, MRI and CBCT, plays a crucial role in accurate diagnosis. Early recognition is particularly important for dental practitioners to avoid inadvertent haemorrhage during routine dental procedures and to ensure appropriate patient management. MRI demonstrated a lobulated T2/STIR hyperintense lesion in the left masticator space with multiple hypointense phleboliths and avid heterogeneous post-contrast enhancement. CBCT revealed multiple radiopaque foci in the left mandibular ramus region, suggestive of phleboliths. The overall clinical and radiological findings were suggestive of a slow-flow venous malformation.