Bilateral Intraosseous Vascular Malformation of the Mandible

A 69-year-old male was referred for evaluation of the mandibular bone, especially on the left side. The radiologist identified bilateral irregular, tortuous intraosseous channels within the body and ramus of the mandible, predominantly inferior to the inferior alveolar canals with multiple connections to them. Additional foramina along the lingual cortical surfaces and bilateral lingual cortical thinning were noted without frank cortical destruction or aggressive periosteal reaction, findings most consistent with an intraosseous vascular malformation. The bilateral distribution was particularly unusual, as these lesions are typically unilateral. Advanced medical imaging was recommended to characterize flow dynamics and lesion extent, and invasive dental or surgical procedures should be deferred until the vascular nature is fully characterized, given the potential for dangerous bleeding.