Masseter Muscle Haemangioma with Calcifications Showing Turkey Wattle Sign: A Case Report with Review of Literature

Haemangiomas are unusual benign vascular tumours affecting skeletal muscle (masseter) in less than 1% of cases in the head and neck region. An intramuscular haemangioma of the masseter muscle is often mistaken for a parotid swelling. This case report emphasises the importance of investigations for accurate preoperative diagnosis, along with a literature review. A 43-year-old male patient presented with a chief complaint of swelling on the lower right side of the face for the past six years. Examination revealed a diffuse swelling on the right lower third of the face, extending anteroposteriorly from the right corner of the mouth to the right tragus of the ear. Superoinferiorly, the lesion extended from the right ala tragus line to the inferior border of the mandible. On palpation, the swelling was non-tender, soft, and less compressible, with no pulsations felt. Furthermore, the swelling appeared more prominent during contraction of the masseter muscle, which is termed as the “Turkey Wattle Sign.” Doppler ultrasound imaging showed a relatively well-defined mixed reflective mass measuring 28×10 mm, with internal hypoechoic cystic and solid areas in the intramuscular compartment of the right masseter muscle. Magnetic Resonance Imaging (MRI) of the neck revealed a well-defined, non-enhancing, lobulated, heterogeneous lesion measuring about 2.1×1.4×2.4 cm in the right masseter muscle. Surgical excision was performed using a right submandibular approach under general anaesthesia. Histopathological examination of the specimen showed loose fibro-collagenous tissue and dilated vascular channels between skeletal muscle fibers, with a few calcifications suggestive of an intramuscular haemangioma. The turkey wattle sign, combined with appropriate radiographic interventions, can correctly diagnose intramuscular haemangiomas with calcifications.