Bony venous malformations in facial bones: Diagnosis and treatment of improperly called cavernous hemangioma

This case series and literature review introduces Bony Vascular Malformations (BVM) of facial bones as a well-defined entity to provide a more accurate reference to these often mislabeled vascular anomalies, aiming to standardize terminology, elucidate their clinical-radiological features and guide their management. This retrospective review analyzes 20 patients treated between 2017 and 2024, all affected by venous malformations involving facial bones. Facial BVMs are apparently rarer than spine or skull bony venous malformations, but they are often misdiagnosed as hemangiomas and, as such statistics are unreliable. Patients presented with symptoms such as facial asymmetry, pain or malocclusion, depending on lesion location. Diagnosis was done on CT scans and confirmed at MRI, when needed. Histopathology offered diagnostic value. Treatment should be tailored, with surgical en-bloc resection remaining the mainstay, but a partial or a more conservative approach might be preferred for treating BVMs of the jaws, with decision-making driven by lesion location, patients' age, symptoms and risk of complications. Outcomes were favorable, with no periprocedural complications and durable symptom control. By defining BVM as a unified diagnostic category, the Authors aim to support a more consistent classification. Inference from this large case series provides clou for diagnosis and suggests tailored management. LEVEL OF EVIDENCE: Case series: level 4.